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NPI Code Detail

MEDICARE: CARRIE STALLER DC

MEDICARE: CARRIE STALLER DC
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
1111N00000XChiropractorCH 9597FL
2111N00000XChiropractor5101OR

General Provider Information

NPI Number : 1578717104
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARRIE STALLER DC
Provider Business Mailing Address
First Line : 5308 SE RHONE ST
Second Line :
City : PORTLAND
State : OR
Zip : 97206-2962
Country : US
Telephone Number : 503-775-6885
Fax Number : 503-775-2451
Provider Business Practice Location Address
First Line : 5308 SE RHONE ST
Second Line :
City : PORTLAND
State : OR
Zip : 97206-2962
Country : US
Telephone Number : 503-775-6885
Fax Number : 503-775-2451
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/10/2008
Last Update Date : 08/20/2013

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Directions to “ CARRIE STALLER DC” Practice Location

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