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NPI Code Detail

MEDICARE: ILLUMINATION CHIROPRACTIC, LLC

MEDICARE: ILLUMINATION 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
1261Q00000XClinic/Center

General Provider Information

NPI Number : 1760256838
Entity Type Code : Organization
Provider Name (Legal Business Name) : ILLUMINATION CHIROPRACTIC, LLC
Provider Business Mailing Address
First Line : 690 N MAIN ST
Second Line :
City : MOUNT ANGEL
State : OR
Zip : 97362-9518
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 690 N MAIN ST
Second Line :
City : MOUNT ANGEL
State : OR
Zip : 97362-9518
Country : US
Telephone Number : 971-599-2536
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. RACHEL MARIE KOHN
Credential : DC
Telephone Number : 971-599-2536
Provider Enumeration Date : 11/09/2023
Last Update Date : 11/09/2023

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Directions to “ILLUMINATION CHIROPRACTIC, LLC ” Practice Location

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