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General NPI Number Information
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NPI Number | 1053836247
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Entity Type | Organization
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Legal Business Name | PORTLAND OPTIMAL WELLNESS, LLC
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Dates
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Enumeration Date | 08/08/2017
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Last Update Date | 08/08/2017
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Provider Practice Location Address
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Address Line | 14511 WESTLAKE DR STE 148
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City | LAKE OSWEGO
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State | OR
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Zip | 97035-7773
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Country | US
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Telephone | 503-941-5351
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Fax |
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Provider Business Mailing Address
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Address Line | 14511 WESTLAKE DR STE 148
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City | LAKE OSWEGO
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State | OR
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Zip | 97035-7773
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Country | US
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Telephone |
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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. AARON DAVISON
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Credential | DC
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Telephone | 503-686-4448
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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 | 4036
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License Number State | OR
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