Healthcare Provider Details

I. General information

NPI: 1184406738
Provider Name (Legal Business Name): GREGORY OLTMANN DC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2023
Last Update Date: 04/10/2024
Certification Date: 04/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12700 SW NORTH DAKOTA ST STE 180
TIGARD OR
97223-0802
US

IV. Provider business mailing address

12700 SW NORTH DAKOTA ST STE 180
TIGARD OR
97223-0802
US

V. Phone/Fax

Practice location:
  • Phone: 503-716-8281
  • Fax: 503-716-8783
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GREGORY ALAN OLTMANN
Title or Position: CHIROPRACTOR/OWNER
Credential: DC
Phone: 503-888-1314