=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669625075
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DREW HOHENSEE D.C., CCSP
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/29/2008
-----------------------------------------------------
Last Update Date | 04/17/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8196 SW HALL BLVD STE 112
-----------------------------------------------------
City | BEAVERTON
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97008-4676
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-924-6535
-----------------------------------------------------
Fax | 503-270-5266
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5585 SW 160TH AVE
-----------------------------------------------------
City | BEAVERTON
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97007-3540
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-924-6535
-----------------------------------------------------
Fax | 503-270-5266
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NS0005X
-----------------------------------------------------
Taxonomy Name | Sports Physician Chiropractor
-----------------------------------------------------
License Number | 3883
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------