=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629137070
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EQUILIBRIUM LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/08/2006
-----------------------------------------------------
Last Update Date | 08/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 913 SW 16TH AVE
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97205-1730
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-228-5000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 913 SW 16TH AVE
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97205-1730
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-228-5000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER, PRACTITIONER
-----------------------------------------------------
Name | NICOLE BHALERAO
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 503-228-5000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 273254
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 273255
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------