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General NPI Number Information
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NPI Number | 1336307677
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Entity Type | Organization
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Legal Business Name | LAKE GROVE CHIROPRACTIC, PC
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Dates
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Enumeration Date | 05/22/2008
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Last Update Date | 05/22/2008
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Provider Practice Location Address
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Address Line | 17620 PILKINGTON RD
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City | LAKE OSWEGO
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State | OR
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Zip | 97035-5361
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Country | US
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Telephone | 503-636-2265
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Fax | 503-636-9862
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Provider Business Mailing Address
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Address Line | 17620 PILKINGTON RD
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City | LAKE OSWEGO
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State | OR
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Zip | 97035-5361
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Country | US
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Telephone | 503-636-2265
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Fax | 503-636-9862
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. SHAWN IRENE HARRINGTON
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Credential | D.C.
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Telephone | 503-636-2265
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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 | 2221
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License Number State | OR
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