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General NPI Number Information
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NPI Number | 1992835870
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Entity Type | Organization
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Legal Business Name | YAZVAC CHIROPRACTIC ASSOCIATES
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2119 NE HALSEY ST
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City | PORTLAND
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State | OR
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Zip | 97232-1522
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Country | US
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Telephone | 503-249-2121
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Fax | 503-331-1069
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Provider Business Mailing Address
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Address Line | 2119 NE HALSEY ST
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City | PORTLAND
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State | OR
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Zip | 97232-1522
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Country | US
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Telephone | 503-249-2121
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Fax | 503-331-1069
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. DAWN L HEATER
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Credential |
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Telephone | 503-249-2121
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | 27 3470
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License Number State | OR
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