Healthcare Provider Details

I. General information

NPI: 1811839475
Provider Name (Legal Business Name): AGUSTIN FERNANDEZ ALONSO DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12720 SW PACIFIC HWY STE 1
TIGARD OR
97223-6125
US

IV. Provider business mailing address

12720 SW PACIFIC HWY STE 1
TIGARD OR
97223-6125
US

V. Phone/Fax

Practice location:
  • Phone: 506-444-1089
  • Fax: 503-296-2703
Mailing address:
  • Phone: 503-444-1089
  • Fax: 503-296-2703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6508
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: