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General NPI Number Information
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NPI Number | 1659882645
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Entity Type | Organization
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Legal Business Name | PREMIER CHIROPRACTIC PC
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Dates
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Enumeration Date | 10/17/2017
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Last Update Date | 10/17/2017
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Provider Practice Location Address
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Address Line | 3000 MARKET ST NE STE 268
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City | SALEM
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State | OR
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Zip | 97301-1809
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Country | US
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Telephone | 503-584-1620
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Fax | 503-990-6985
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Provider Business Mailing Address
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Address Line | 3000 MARKET ST NE STE 268
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City | SALEM
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State | OR
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Zip | 97301-1809
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Country | US
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Telephone | 503-584-1620
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Fax | 503-990-6985
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Authorized Official
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Title or Position | SECRETARY
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Name | DR. DAVID STREET
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Credential | DC
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Telephone | 805-400-5259
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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 |
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License Number State |
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