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General NPI Number Information
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NPI Number | 1386424539
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Entity Type | Individual
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Provider Name | LILY HOOG-FRY
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Gender | Female
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Dates
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Enumeration Date | 10/04/2023
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Last Update Date | 10/04/2023
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Provider Practice Location Address
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Address Line | 38953 PIONEER BLVD
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City | SANDY
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State | OR
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Zip | 97055-8080
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Country | US
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Telephone | 503-954-3676
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Fax |
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Provider Business Mailing Address
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Address Line | 1615 N JANTZEN AVE
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City | PORTLAND
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State | OR
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Zip | 97217-7822
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Country | US
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Telephone | 775-813-3184
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 6330
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License Number State | OR
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