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General NPI Number Information
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NPI Number | 1477814101
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Entity Type | Organization
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Legal Business Name | AGILE CHIROPRACTIC, PC
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Dates
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Enumeration Date | 05/29/2012
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Last Update Date | 05/29/2012
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Provider Practice Location Address
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Address Line | 1895 NW 188TH AVE
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City | HILLSBORO
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State | OR
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Zip | 97006-6485
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Country | US
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Telephone | 503-718-7161
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Fax | 503-268-1691
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Provider Business Mailing Address
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Address Line | 1481 NE ZACHARY ST
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City | HILLSBORO
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State | OR
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Zip | 97124-4058
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAYLENE LEWIS
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Credential | D.C.
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Telephone | 503-621-7919
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 3354
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License Number State | OR
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