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General NPI Number Information
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NPI Number | 1861707879
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Entity Type | Organization
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Legal Business Name | ACTIVE CHIROPRACTIC AND REHABILITATION, LLC
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Dates
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Enumeration Date | 08/13/2010
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Last Update Date | 08/13/2010
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Provider Practice Location Address
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Address Line | 238 SE WASHINGTON ST STE B
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City | HILLSBORO
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State | OR
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Zip | 97123-4279
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Country | US
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Telephone | 503-648-1088
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Fax | 503-648-0748
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Provider Business Mailing Address
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Address Line | 238 SE WASHINGTON ST STE B
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City | HILLSBORO
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State | OR
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Zip | 97123-4279
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Country | US
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Telephone | 503-648-1088
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Fax | 503-648-0748
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Authorized Official
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Title or Position | OWNER/SOLE MEMBER
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Name | DR. PATRICK D BOURLON
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Credential | DC
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Telephone | 503-648-1088
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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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