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NPI Code Detail

MEDICARE: DR. RANDALL HUGH LEAVITT D.C.

MEDICARE: DR. RANDALL HUGH LEAVITT 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
1111N00000XChiropractor273413OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1320163233OTHERORTID

General Provider Information

NPI Number : 1982787891
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RANDALL HUGH LEAVITT D.C.
Provider Business Mailing Address
First Line : 9437 NW GERMANTOWN RD
Second Line :
City : PORTLAND
State : OR
Zip : 97231-2719
Country : US
Telephone Number : 503-816-2184
Fax Number :
Provider Business Practice Location Address
First Line : 2330 NW FLANDERS ST STE 101
Second Line :
City : PORTLAND
State : OR
Zip : 97210-3400
Country : US
Telephone Number : 503-228-5000
Fax Number : 503-228-5019
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/23/2006
Last Update Date : 05/16/2025

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