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General NPI Number Information
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NPI Number | 1033072251
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Entity Type | Organization
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Legal Business Name | FORM & FUNCTION CHIROPRACTIC PC
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Dates
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Enumeration Date | 12/04/2025
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 3 MONROE PKWY STE G
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City | LAKE OSWEGO
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State | OR
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Zip | 97035-8874
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Country | US
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Telephone | 503-495-3454
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Fax |
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Provider Business Mailing Address
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Address Line | 3 MONROE PKWY STE G
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City | LAKE OSWEGO
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State | OR
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Zip | 97035-8874
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Country | US
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Telephone | 503-495-3454
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Fax |
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Authorized Official
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Title or Position | PARTNER/DR
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Name | JEFF DEVINE
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Credential | DC
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Telephone | 503-330-3289
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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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