Healthcare Provider Details

I. General information

NPI: 1194883959
Provider Name (Legal Business Name): SHEPHARD CLINIC OF THE CHIROPRACTIC ARTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 06/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 NW FLANDERS
PORTLAND OR
97210
US

IV. Provider business mailing address

2323 NW FLANDERS
PORTLAND OR
97210
US

V. Phone/Fax

Practice location:
  • Phone: 503-223-3826
  • Fax: 503-223-0742
Mailing address:
  • Phone: 503-223-3826
  • Fax: 503-223-0742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number StateOR

VIII. Authorized Official

Name: DR. SCOTT B. SHEPHARD
Title or Position: PRESIDENT
Credential: DC
Phone: 503-223-3826