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General NPI Number Information
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NPI Number | 1588014609
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Entity Type | Organization
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Legal Business Name | THE RIDGE CHIROPRACTIC WELLNESS CLINIC
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Dates
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Enumeration Date | 06/20/2016
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Last Update Date | 06/20/2016
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Provider Practice Location Address
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Address Line | 1046 NE ORENCO STATION PKWY
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City | HILLSBORO
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State | OR
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Zip | 97124-7015
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Country | US
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Telephone | 503-747-7473
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Fax |
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Provider Business Mailing Address
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Address Line | 1046 NE ORENCO STATION PKWY
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City | HILLSBORO
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State | OR
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Zip | 97124-7015
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Country | US
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Telephone | 503-747-7473
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOSHUA A KNUTSON
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Credential | DC
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Telephone | 503-747-7473
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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 | 3802
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License Number State | OR
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