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General NPI Number Information
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NPI Number | 1225882012
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Entity Type | Organization
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Legal Business Name | CHIROPRACTIC ADVANTAGE INC
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Dates
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Enumeration Date | 04/16/2024
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Last Update Date | 10/07/2024
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Provider Practice Location Address
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Address Line | 3990 CHERRY AVE NE STE 102
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City | KEIZER
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State | OR
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Zip | 97303-4888
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Country | US
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Telephone | 971-332-5919
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Fax |
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Provider Business Mailing Address
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Address Line | 3990 CHERRY AVE NE STE 102
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City | KEIZER
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State | OR
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Zip | 97303-4888
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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 | PROVIDER
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Name | JASON HOLT
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Credential |
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Telephone | 971-332-5919
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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