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General NPI Number Information
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NPI Number | 1457537854
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Entity Type | Organization
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Legal Business Name | HAWTHORN FARM ATHLETIC CLUB
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Dates
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Enumeration Date | 01/15/2008
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Last Update Date | 01/15/2008
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Provider Practice Location Address
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Address Line | 4800 NE BELKNAP CT
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City | HILLSBORO
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State | OR
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Zip | 97124-6441
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Country | US
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Telephone | 503-640-6404
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Fax | 503-640-0644
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Provider Business Mailing Address
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Address Line | 4800 NE BELKNAP CT
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City | HILLSBORO
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State | OR
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Zip | 97124-6441
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Country | US
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Telephone | 503-640-6404
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Fax | 503-640-0644
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. JOHN HOWELL
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Credential | DC
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Telephone | 503-640-6404
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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 | 713682
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License Number State | OR
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