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General NPI Number Information
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NPI Number | 1992068225
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Entity Type | Organization
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Legal Business Name | ULTRA CHIROPRACTIC AND REHABILITATION, LLC
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Dates
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Enumeration Date | 06/21/2012
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Last Update Date | 12/16/2013
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Provider Practice Location Address
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Address Line | 1977 NW OVERTON ST SUITE C
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City | PORTLAND
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State | OR
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Zip | 97209-2339
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Country | US
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Telephone | 503-208-4085
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Fax | 503-223-1222
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Provider Business Mailing Address
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Address Line | 1977 NW OVERTON ST SUITE C
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City | PORTLAND
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State | OR
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Zip | 97209-1618
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Country | US
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Telephone | 503-208-4084
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Fax | 503-223-1222
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Authorized Official
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Title or Position | CHIROPRACTIC PHYSICIAN
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Name | MEGAN LEEANN ZETTER
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Credential | D.C.
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Telephone | 503-347-8988
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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 | 5030
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License Number State | OR
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