Healthcare Provider Details

I. General information

NPI: 1750823670
Provider Name (Legal Business Name): CHRISTOPHER T STEVENSON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2016
Last Update Date: 06/07/2024
Certification Date: 06/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 LANSING AVE. NE
SALEM OR
97301
US

IV. Provider business mailing address

1707 LANSING AVE. NE
SALEM OR
97301
US

V. Phone/Fax

Practice location:
  • Phone: 503-589-0700
  • Fax: 503-586-0255
Mailing address:
  • Phone: 503-589-0700
  • Fax: 503-586-0255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3784
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number15336
License Number StateOR

VIII. Authorized Official

Name: DR. CHRISTOPHER STEVENSON
Title or Position: OWNER
Credential: D.C.
Phone: 330-418-9930