=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386843159
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HEIDI TORNBERG D.C.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2007
-----------------------------------------------------
Last Update Date | 09/20/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 700 DEBORAH RD SUITE 270
-----------------------------------------------------
City | NEWBERG
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97132-2198
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-538-5433
-----------------------------------------------------
Fax | 503-537-5153
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 700 DEBORAH RD SUITE 270
-----------------------------------------------------
City | NEWBERG
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97132-2198
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-538-5433
-----------------------------------------------------
Fax | 503-537-5153
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 3752
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------