MEDICARE: DR. BARRY D SHULAK 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	111N00000X	Chiropractor	3716	OR

General Provider Information

NPI Number	:	1649466780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BARRY D SHULAK D.C.

Provider Business Mailing Address
First Line	:	8225 SW APPLE WAY
Second Line	:	STE 100
City	:	PORTLAND
State	:	OR
Zip	:	97225-1783
Country	:	US
Telephone Number	:	503-245-8445
Fax Number	:	503-292-4550

Provider Business Practice Location Address
First Line	:	1623 NE BROADWAY ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97232-1425
Country	:	US
Telephone Number	:	503-313-2576
Fax Number	:	503-715-0511

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

Provider Enumeration Date	:	09/21/2007
Last Update Date	:	10/26/2018

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