=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982620308
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTERED IN MOTION, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/15/2006
-----------------------------------------------------
Last Update Date | 02/09/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9220 SW BARBUR BLVD SUITE 105-A
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97219-5428
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-517-0916
-----------------------------------------------------
Fax | 503-517-0534
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9220 SW BARBUR BLVD SUITE 119-347
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97219-5428
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-517-0916
-----------------------------------------------------
Fax | 503-517-0534
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | CLAUDIA HOLDEREGGER
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 503-517-0916
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 3482
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------