=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013277722
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TOTAL FAMILY CHIROPRACTIC P C
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/29/2012
-----------------------------------------------------
Last Update Date | 07/15/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4309 SE WOODSTOCK BLVD STE 120
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97206-6212
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-777-4221
-----------------------------------------------------
Fax | 503-777-4349
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4309 SE WOODSTOCK BLVD STE 120
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97206-6212
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-777-4221
-----------------------------------------------------
Fax | 503-777-4349
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR / OWNER
-----------------------------------------------------
Name | DR. DAVID SCOTT CONKLIN
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 503-777-4221
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 2681
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------