=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174841175
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INNER-BALANCE CHIROPRACTIC LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/14/2010
-----------------------------------------------------
Last Update Date | 10/01/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 22400 SE STARK ST
-----------------------------------------------------
City | GRESHAM
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97030-2656
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-907-0100
-----------------------------------------------------
Fax | 503-907-0098
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3021 SE PHEASANT AVE
-----------------------------------------------------
City | GRESHAM
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97080-8260
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. MILKAKA STRINGHAM
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 503-907-0100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 3988
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------