MEDICARE: NORTH PLAINS CHIROPRACTIC CLINIC INC

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	111NS0005X	Sports Physician Chiropractor	3450	OR

General Provider Information

NPI Number	:	1902936958
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH PLAINS CHIROPRACTIC CLINIC INC

Provider Business Mailing Address
First Line	:	10355 NW GLENCOE RD
Second Line	:	SUITE B
City	:	NORTH PLAINS
State	:	OR
Zip	:	97133-8244
Country	:	US
Telephone Number	:	503-647-9944
Fax Number	:	503-447-5011

Provider Business Practice Location Address
First Line	:	10355 NW GLENCOE RD
Second Line	:	SUITE B
City	:	NORTH PLAINS
State	:	OR
Zip	:	97133-8244
Country	:	US
Telephone Number	:	503-647-9944
Fax Number	:	503-447-5011

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SHANE E ESPINOZA
Credential	:	DC, CCSP
Telephone Number	:	503-647-9944

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	04/02/2013

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