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General NPI Number Information
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NPI Number | 1477794295
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Entity Type | Organization
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Legal Business Name | EQUILIBRIUM
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Dates
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Enumeration Date | 03/09/2009
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Last Update Date | 03/09/2009
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Provider Practice Location Address
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Address Line | 1706 NW GLISAN ST STE 5
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City | PORTLAND
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State | OR
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Zip | 97209-2229
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Country | US
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Telephone | 503-228-5000
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Fax | 503-228-5019
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Provider Business Mailing Address
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Address Line | 1706 NW GLISAN ST STE 5
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City | PORTLAND
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State | OR
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Zip | 97209-2229
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Country | US
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Telephone | 503-228-5000
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Fax | 503-228-5019
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Authorized Official
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Title or Position | OWNER/CHIROPRACTOR
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Name | NICOLE BHALERAO
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Credential | D.C.
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Telephone | 503-228-5000
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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 | 3863
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License Number State | OR
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