=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194883959
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHEPHARD CLINIC OF THE CHIROPRACTIC ARTS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/05/2006
-----------------------------------------------------
Last Update Date | 06/27/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2323 NW FLANDERS
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97210
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-223-3826
-----------------------------------------------------
Fax | 503-223-0742
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2323 NW FLANDERS
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97210
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-223-3826
-----------------------------------------------------
Fax | 503-223-0742
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. SCOTT B. SHEPHARD
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 503-223-3826
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 302R00000X
-----------------------------------------------------
Taxonomy Name | Health Maintenance Organization
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------