MEDICARE: DR. JOSEPH ELIAS VANCE D.C.

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	111NN0400X	Neurology Chiropractor	OR4017	OR
2	111N00000X	Chiropractor	4017	OR

General Provider Information

NPI Number	:	1407119605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH ELIAS VANCE D.C.

Provider Business Mailing Address
First Line	:	8047 SW 56TH AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97219-3220
Country	:	US
Telephone Number	:	404-661-8833
Fax Number	:

Provider Business Practice Location Address
First Line	:	4670 SW WASHINGTON AVE
Second Line	:
City	:	BEAVERTON
State	:	OR
Zip	:	97005-0530
Country	:	US
Telephone Number	:	503-646-8575
Fax Number	:	503-526-0783

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2012
Last Update Date	:	08/04/2021

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