MEDICARE: ROGUE SPINE CENTER 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
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1376212464
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROGUE SPINE CENTER LLC

Provider Business Mailing Address
First Line	:	2525 NW LOVEJOY ST STE 101
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97210-2861
Country	:	US
Telephone Number	:	503-746-9926
Fax Number	:

Provider Business Practice Location Address
First Line	:	2525 NW LOVEJOY ST STE 101
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97210-2861
Country	:	US
Telephone Number	:	503-746-9926
Fax Number	:

Authorized Official
Title or Position	:	CHIROPRACTIC OWNER
Name	:	DR. GRANT SCHOEN
Credential	:	DC
Telephone Number	:	503-327-5797

Provider Enumeration Date	:	09/10/2021
Last Update Date	:	08/03/2022

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Directions to “ROGUE SPINE CENTER LLC ” Practice Location

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