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General NPI Number Information
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NPI Number | 1154600567
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Entity Type | Organization
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Legal Business Name | C AND C CHIROPRACTIC
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Dates
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Enumeration Date | 08/16/2011
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Last Update Date | 08/16/2011
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Provider Practice Location Address
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Address Line | 17200 NW CORRIDOR CT SUITE 100
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City | BEAVERTON
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State | OR
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Zip | 97006-3295
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Country | US
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Telephone | 503-617-0906
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Fax | 503-617-0949
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Provider Business Mailing Address
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Address Line | 17200 NW CORRIDOR CT SUITE 100
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City | BEAVERTON
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State | OR
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Zip | 97006-3295
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Country | US
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Telephone | 503-617-0906
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Fax | 503-617-0949
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MARIA ESTELA MANDUJANO
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Credential |
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Telephone | 503-617-0906
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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 | 3215
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License Number State | OR
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