MEDICARE: NW FAMILY CHIROPRACTIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	3961	OR

General Provider Information

NPI Number	:	1023360245
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NW FAMILY CHIROPRACTIC

Provider Business Mailing Address
First Line	:	1797 LANSING AVE NE
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97301-8732
Country	:	US
Telephone Number	:	503-391-9112
Fax Number	:

Provider Business Practice Location Address
First Line	:	1797 LANSING AVE NE
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97301-8732
Country	:	US
Telephone Number	:	503-391-9112
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ANDREW ISAKSEN
Credential	:	DC
Telephone Number	:	503-391-9112

Provider Enumeration Date	:	10/11/2012
Last Update Date	:	01/14/2013

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Directions to “NW FAMILY CHIROPRACTIC ” Practice Location

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