MEDICARE: RENE ST. CYR CHIROPRACTIC PHYSICIAN

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	27-3003	OR

General Provider Information

NPI Number	:	1518233014
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENE ST. CYR CHIROPRACTIC PHYSICIAN

Provider Business Mailing Address
First Line	:	4111 NE. TILLAMOOK ST.
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97212-5342
Country	:	US
Telephone Number	:	503-281-3400
Fax Number	:	503-287-3787

Provider Business Practice Location Address
First Line	:	4111 NE. TILLAMOOK ST.
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97212-5342
Country	:	US
Telephone Number	:	503-281-3400
Fax Number	:	503-287-3787

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	MR. RENE CARL ST. CYR
Credential	:	D.C.
Telephone Number	:	503-281-3400

Provider Enumeration Date	:	03/29/2012
Last Update Date	:	03/29/2012

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