Healthcare Provider Details

I. General information

NPI: 1205175999
Provider Name (Legal Business Name): DOCTORS CHOICE PAIN MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2013
Last Update Date: 01/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1880 LANCASTER DR NE SUITE 101-102
SALEM OR
97305-1089
US

IV. Provider business mailing address

1880 LANCASTER DR NE SUITE 101-102
SALEM OR
97305-1089
US

V. Phone/Fax

Practice location:
  • Phone: 503-362-1002
  • Fax: 503-362-1006
Mailing address:
  • Phone: 503-362-1002
  • Fax: 503-362-1006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: DESIREE WHITMIRE
Title or Position: MANGER
Credential:
Phone: 503-362-1006