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NPI Code Detail

MEDICARE: STAYTON CHIROPRACTIC, LLC

MEDICARE: STAYTON 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
1111N00000XChiropractor

General Provider Information

NPI Number : 1477011245
Entity Type Code : Organization
Provider Name (Legal Business Name) : STAYTON CHIROPRACTIC, LLC
Provider Business Mailing Address
First Line : 561 N 1ST AVE
Second Line :
City : STAYTON
State : OR
Zip : 97383-1703
Country : US
Telephone Number : 503-767-3410
Fax Number : 503-767-3411
Provider Business Practice Location Address
First Line : 561 N 1ST AVE
Second Line :
City : STAYTON
State : OR
Zip : 97383-1703
Country : US
Telephone Number : 503-767-3410
Fax Number : 503-767-3411
Authorized Official
Title or Position : ONWER/CHIROPRACTIC PHYSICIAN
Name : CODY LEDER
Credential : DC
Telephone Number : 503-767-3410
Provider Enumeration Date : 03/11/2019
Last Update Date : 03/11/2019

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Directions to “STAYTON CHIROPRACTIC, LLC ” Practice Location

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