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General NPI Number Information
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NPI Number | 1962844324
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Entity Type | Organization
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Legal Business Name | PORTLAND MASSAGE AND CHIROPRACTIC SERVICES LLC
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Dates
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Enumeration Date | 07/25/2013
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Last Update Date | 07/25/2013
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Provider Practice Location Address
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Address Line | 7542 SW 35TH AVE
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City | PORTLAND
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State | OR
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Zip | 97219-1749
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Country | US
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Telephone | 503-347-7668
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Fax |
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Provider Business Mailing Address
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Address Line | 7542 SW 35TH AVE
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City | PORTLAND
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State | OR
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Zip | 97219-1749
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Country | US
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Telephone | 503-347-7668
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. JEFFREY R. DOUGAL
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Credential | D.C.
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Telephone | 503-347-7668
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 13436
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 3680
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License Number State | OR
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