MEDICARE: AMBROSE 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
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1790370732
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMBROSE LLC

Provider Business Mailing Address
First Line	:	4985 BATTLE CREEK RD SE STE 140
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-9684
Country	:	US
Telephone Number	:	503-583-7194
Fax Number	:

Provider Business Practice Location Address
First Line	:	4985 BATTLE CREEK RD SE STE 125
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-9684
Country	:	US
Telephone Number	:	503-583-7194
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JORDAN M AMBROSE
Credential	:	DC
Telephone Number	:	503-583-7194

Provider Enumeration Date	:	03/02/2021
Last Update Date	:	03/04/2026

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Directions to “AMBROSE LLC ” Practice Location

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