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NPI Code Detail

MEDICARE: STUMPTOWN CHIROPRACTIC, LLC

MEDICARE: STUMPTOWN CHIROPRACTIC, LLC
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
1111N00000XChiropractor5660OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11174896724OTHERORNPI
21205312170OTHERNPI TYPE 2

General Provider Information

NPI Number : 1205312170
Entity Type Code : Organization
Provider Name (Legal Business Name) : STUMPTOWN CHIROPRACTIC, LLC
Provider Business Mailing Address
First Line : 7232 N BURLINGTON AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97203-4817
Country : US
Telephone Number : 503-893-8336
Fax Number : 503-662-7324
Provider Business Practice Location Address
First Line : 7232 N BURLINGTON AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97203-4817
Country : US
Telephone Number : 503-893-8336
Fax Number : 503-662-7324
Authorized Official
Title or Position : CHIROPRACTOR/OWNER
Name : DR. MELISSA BARTOSZEWSKI
Credential : DC
Telephone Number : 503-893-8336
Provider Enumeration Date : 07/13/2018
Last Update Date : 10/23/2020

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Directions to “STUMPTOWN CHIROPRACTIC, LLC ” Practice Location

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