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General NPI Number Information
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NPI Number | 1285167163
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Entity Type | Organization
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Legal Business Name | ACCIDENT CARE CHIROPRACTIC AND MASSAGE
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Dates
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Enumeration Date | 04/06/2017
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Last Update Date | 04/06/2017
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Provider Practice Location Address
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Address Line | 790 E POWELL BLVD
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City | GRESHAM
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State | OR
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Zip | 97030-7616
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Country | US
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Telephone | 503-660-8552
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Fax |
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Provider Business Mailing Address
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Address Line | 790 E POWELL BLVD
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City | GRESHAM
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State | OR
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Zip | 97030-7616
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Country | US
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Telephone | 503-660-8552
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DARREN FAHERTY
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Credential | DC
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Telephone | 503-660-8552
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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 | 4063
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License Number State | OR
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