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General NPI Number Information
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NPI Number | 1003368275
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Entity Type | Organization
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Legal Business Name | BE WELL CORVALLIS CHIROPRACTIC
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Dates
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Enumeration Date | 11/03/2016
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Last Update Date | 08/23/2017
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Provider Practice Location Address
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Address Line | 2721 NW 9TH ST
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City | CORVALLIS
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State | OR
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Zip | 97330-3857
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Country | US
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Telephone | 541-754-1577
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Fax |
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Provider Business Mailing Address
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Address Line | 2721 NW 9TH ST
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City | CORVALLIS
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State | OR
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Zip | 97330-3857
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Country | US
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Telephone | 541-754-1577
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Fax |
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Authorized Official
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Title or Position | OWNER/CHIROPRACTOR
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Name | CHAD RANDALL LAMER
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Credential | D.C.
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Telephone | 605-695-5419
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 5014
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License Number State | OR
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