Healthcare Provider Details

I. General information

NPI: 1437311438
Provider Name (Legal Business Name): HIGHER PERFORMANCE LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 06/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8683 WARNER DR SE
SALEM OR
97317-9046
US

IV. Provider business mailing address

PO BOX 13249
SALEM OR
97309-1249
US

V. Phone/Fax

Practice location:
  • Phone: 971-239-4576
  • Fax: 503-362-7250
Mailing address:
  • Phone: 971-239-4576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3812
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number3812
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number3812
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number3812
License Number StateOR
# 5
Primary TaxonomyN
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License Number3812
License Number StateOR
# 6
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number3812
License Number StateOR
# 7
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number3812
License Number StateOR
# 8
Primary TaxonomyN
Taxonomy Code111NT0100X
TaxonomyThermography Chiropractor
License Number3812
License Number StateOR
# 9
Primary TaxonomyN
Taxonomy Code111NX0100X
TaxonomyOccupational Health Chiropractor
License Number3812
License Number StateOR
# 10
Primary TaxonomyN
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number3812
License Number StateOR

VIII. Authorized Official

Name: DR. HARLEM HOSPICIO PROCULO QUIJANO
Title or Position: PRESIDENT
Credential: D.C.
Phone: 971-239-4576