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General NPI Number Information
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NPI Number | 1003423914
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Entity Type | Organization
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Legal Business Name | EVERGREEN CHIROPRACTIC PC
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Dates
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Enumeration Date | 09/24/2020
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Last Update Date | 03/05/2021
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Provider Practice Location Address
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Address Line | 657 NE HOOD AVE
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City | GRESHAM
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State | OR
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Zip | 97030-7328
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Country | US
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Telephone | 503-912-1156
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Fax | 971-292-2932
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Provider Business Mailing Address
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Address Line | 5920 BURMA RD
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City | LAKE OSWEGO
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State | OR
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Zip | 97035-3240
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Country | US
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Telephone | 971-330-8017
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR/OWNER
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Name | DR. MICHAEL JARED MANNS
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Credential | DC
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Telephone | 503-912-1156
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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