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General NPI Number Information
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NPI Number | 1083101679
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Entity Type | Organization
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Legal Business Name | NWMC CHIROPRACTIC AND WELLNESS LLC
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Dates
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Enumeration Date | 04/18/2018
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Last Update Date | 04/18/2018
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Provider Practice Location Address
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Address Line | 10247 NE CLACKAMAS ST
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City | PORTLAND
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State | OR
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Zip | 97220-3915
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Country | US
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Telephone | 503-347-2581
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Fax |
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Provider Business Mailing Address
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Address Line | 10247 NE CLACKAMAS ST
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City | PORTLAND
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State | OR
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Zip | 97220-3915
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Country | US
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Telephone | 503-347-2581
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Fax |
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Authorized Official
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Title or Position | DR CHIROPRACTOR
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Name | RICHARD ROGACHEVSKY
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Credential | DC
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Telephone | 503-206-6078
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | 3923
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License Number State | OR
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