Healthcare Provider Details

I. General information

NPI: 1700445210
Provider Name (Legal Business Name): RUBEN ACEVEDO III D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2019
Last Update Date: 10/09/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1813 W HARVARD AVE STE 230
ROSEBURG OR
97471-2755
US

IV. Provider business mailing address

1813 W HARVARD AVE STE 230
ROSEBURG OR
97471-2755
US

V. Phone/Fax

Practice location:
  • Phone: 503-372-6016
  • Fax: 971-205-5484
Mailing address:
  • Phone: 939-280-1858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number6002
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number6002
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6002
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: