=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902936958
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTH PLAINS CHIROPRACTIC CLINIC INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/07/2007
-----------------------------------------------------
Last Update Date | 04/02/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10355 NW GLENCOE RD SUITE B
-----------------------------------------------------
City | NORTH PLAINS
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97133-8244
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-647-9944
-----------------------------------------------------
Fax | 503-447-5011
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10355 NW GLENCOE RD SUITE B
-----------------------------------------------------
City | NORTH PLAINS
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97133-8244
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-647-9944
-----------------------------------------------------
Fax | 503-447-5011
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. SHANE E ESPINOZA
-----------------------------------------------------
Credential | DC, CCSP
-----------------------------------------------------
Telephone | 503-647-9944
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NS0005X
-----------------------------------------------------
Taxonomy Name | Sports Physician Chiropractor
-----------------------------------------------------
License Number | 3450
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------