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General NPI Number Information
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NPI Number | 1043453145
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Entity Type | Organization
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Legal Business Name | ADVANTAGE CHIROPRACTIC CLINIC LLC
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Dates
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Enumeration Date | 04/20/2009
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Last Update Date | 04/26/2009
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Provider Practice Location Address
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Address Line | 9811 SE DIVISION ST
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City | PORTLAND
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State | OR
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Zip | 97266-1335
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Country | US
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Telephone | 503-761-1631
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1989
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City | FAIRVIEW
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State | OR
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Zip | 97024-1809
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Country | US
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Telephone | 503-761-1631
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL THOMAS STUBBS
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Credential |
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Telephone | 503-720-7098
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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 | 3911
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 3821
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License Number State | OR
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