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NPI Code Detail

MEDICARE: KIMBERLY ANN PRIVITERA, PC

MEDICARE: KIMBERLY ANN PRIVITERA, PC
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
1111NX0100XOccupational Health Chiropractor273094OR

General Provider Information

NPI Number : 1184835274
Entity Type Code : Organization
Provider Name (Legal Business Name) : KIMBERLY ANN PRIVITERA, PC
Provider Business Mailing Address
First Line : 8029 SE WOODSTOCK BLVD
Second Line :
City : PORTLAND
State : OR
Zip : 97206-5885
Country : US
Telephone Number : 503-774-1776
Fax Number :
Provider Business Practice Location Address
First Line : 8029 SE WOODSTOCK BLVD
Second Line :
City : PORTLAND
State : OR
Zip : 97206-5885
Country : US
Telephone Number : 503-774-1776
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. KIMBERLY PRIVITERA
Credential : DC
Telephone Number : 503-774-1776
Provider Enumeration Date : 05/24/2007
Last Update Date : 08/22/2020

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Directions to “KIMBERLY ANN PRIVITERA, PC ” Practice Location

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