=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528435385
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RALEIGH CHRISTINE SEKULIC DC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/27/2015
-----------------------------------------------------
Last Update Date | 02/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4412 S BARBUR BLVD SUITE 220
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97239
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-676-6728
-----------------------------------------------------
Fax | 503-676-3316
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4412 S BARBUR BLVD SUITE 220
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97239
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-676-6728
-----------------------------------------------------
Fax | 503-676-3316
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NN1001X
-----------------------------------------------------
Taxonomy Name | Nutrition Chiropractor
-----------------------------------------------------
License Number | 5670
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111NP0017X
-----------------------------------------------------
Taxonomy Name | Pediatric Chiropractor
-----------------------------------------------------
License Number | 5670
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 5670
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------