MEDICARE: BALLAD TOWNE CHIROPRACTIC CLINIC 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
1	111N00000X	Chiropractor	1900	OR
2	111N00000X	Chiropractor	1997	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	033069000	OTHER	OR	ZAPF BLUE CROSS #
2	033068002	OTHER	OR	MCDOWELL BLUE CROSS #

General Provider Information

NPI Number	:	1487669867
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BALLAD TOWNE CHIROPRACTIC CLINIC PC

Provider Business Mailing Address
First Line	:	1905 MTN VIEW LN STE 400
Second Line	:
City	:	FOREST GROVE
State	:	OR
Zip	:	97116-2264
Country	:	US
Telephone Number	:	503-357-2187
Fax Number	:	503-357-2187

Provider Business Practice Location Address
First Line	:	1905 MTN VIEW LN STE 400
Second Line	:
City	:	FOREST GROVE
State	:	OR
Zip	:	97116-2264
Country	:	US
Telephone Number	:	503-357-2187
Fax Number	:	503-357-2187

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BONNIE L MCDOWELL
Credential	:	PT, DC
Telephone Number	:	503-357-2187

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	04/08/2011

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Directions to “BALLAD TOWNE CHIROPRACTIC CLINIC PC ” Practice Location

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