=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033377379
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | T V HIGHWAY CHIROPRACTIC CLINIC PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2008
-----------------------------------------------------
Last Update Date | 02/03/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18055 SW TV HWY
-----------------------------------------------------
City | ALOHA
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97006-3953
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-642-3018
-----------------------------------------------------
Fax | 503-591-9334
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18055 SW TV HWY
-----------------------------------------------------
City | ALOHA
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97006-3953
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-642-3018
-----------------------------------------------------
Fax | 503-591-9334
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR
-----------------------------------------------------
Name | DR. THOMAS A RIES
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 503-642-3018
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM2500X
-----------------------------------------------------
Taxonomy Name | Medical Specialty Clinic/Center
-----------------------------------------------------
License Number | 2433
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------