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General NPI Number Information
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NPI Number | 1043749658
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Entity Type | Organization
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Legal Business Name | DPRCHIRO LLC
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Dates
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Enumeration Date | 06/07/2017
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Last Update Date | 05/13/2020
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Provider Practice Location Address
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Address Line | 8196 SW HALL BLVD STE 106
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City | BEAVERTON
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State | OR
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Zip | 97008-4676
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Country | US
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Telephone | 971-354-6916
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Fax | 971-228-5438
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Provider Business Mailing Address
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Address Line | 4330 SW 188TH AVE
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City | BEAVERTON
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State | OR
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Zip | 97078-1517
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Country | US
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Telephone | 971-354-6916
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Fax | 971-228-5438
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Authorized Official
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Title or Position | MEMBER
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Name | DR. PAULA P RIVERA
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Credential | DC, LMT
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Telephone | 971-354-6916
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 22330
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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 | 5768
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License Number State | OR
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