=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427222025
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHERWOOD FAMILY CHIROPRACTIC CLINIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/15/2008
-----------------------------------------------------
Last Update Date | 04/15/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20508 SW ROY ROGERS RD C-115
-----------------------------------------------------
City | SHERWOOD
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97140-9932
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-906-3585
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20508 SW ROY ROGERS RD C-115
-----------------------------------------------------
City | SHERWOOD
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97140-9932
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-906-3585
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR/OWNER
-----------------------------------------------------
Name | DR. JENNIFER LYNN NIENABER
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 503-906-3585
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 273476
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------