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General NPI Number Information
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NPI Number | 1376212464
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Entity Type | Organization
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Legal Business Name | ROGUE SPINE CENTER LLC
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Dates
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Enumeration Date | 09/10/2021
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Last Update Date | 08/03/2022
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Provider Practice Location Address
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Address Line | 2525 NW LOVEJOY ST STE 101
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City | PORTLAND
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State | OR
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Zip | 97210-2861
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Country | US
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Telephone | 503-746-9926
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Fax |
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Provider Business Mailing Address
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Address Line | 2525 NW LOVEJOY ST STE 101
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City | PORTLAND
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State | OR
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Zip | 97210-2861
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Country | US
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Telephone | 503-746-9926
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTIC OWNER
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Name | DR. GRANT SCHOEN
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Credential | DC
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Telephone | 503-327-5797
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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 |
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License Number State |
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