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General NPI Number Information
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NPI Number | 1376800425
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Entity Type | Organization
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Legal Business Name | CHIROPRACTIC AND REHAB CENTER
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Dates
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Enumeration Date | 04/13/2012
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Last Update Date | 04/13/2012
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Provider Practice Location Address
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Address Line | 3072 LANCASTER DR NE
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City | SALEM
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State | OR
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Zip | 97305-1396
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Country | US
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Telephone | 503-391-0848
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Fax | 503-391-0785
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Provider Business Mailing Address
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Address Line | 3072 LANCASTER DR NE
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City | SALEM
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State | OR
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Zip | 97305-1396
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Country | US
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Telephone | 503-391-0848
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Fax | 503-391-0785
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC
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Name | DR. DAMON PAUL SPINK
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Credential | DC
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Telephone | 503-391-0848
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 2926
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License Number State | OR
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