Healthcare Provider Details

I. General information

NPI: 1952248601
Provider Name (Legal Business Name): CHRISTOPHER L BACKMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40028 BOOTH KELLY RD
SPRINGFIELD OR
97478-9516
US

IV. Provider business mailing address

40028 BOOTH KELLY RD
SPRINGFIELD OR
97478-9516
US

V. Phone/Fax

Practice location:
  • Phone: 385-377-8366
  • Fax:
Mailing address:
  • Phone: 385-377-8366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number10047865
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: