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General NPI Number Information
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NPI Number | 1235593492
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Entity Type | Organization
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Legal Business Name | ACCIDENT AND INJURY CARE, PS
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Dates
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Enumeration Date | 04/13/2016
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Last Update Date | 09/26/2022
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Provider Practice Location Address
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Address Line | 12417 NE GLISAN ST
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City | PORTLAND
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State | OR
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Zip | 97230-2144
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Country | US
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Telephone | 971-255-0301
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Fax | 971-255-0343
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Provider Business Mailing Address
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Address Line | 12417 NE GLISAN ST
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City | PORTLAND
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State | OR
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Zip | 97230-2144
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Country | US
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Telephone | 971-255-0301
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KEVIN MARTIN
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Credential | D.C.
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Telephone | 206-362-3344
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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 | 3718
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License Number State | OR
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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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Taxonomy #3
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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