Provider Demographics
NPI:1104078476
Name:KIRCHEM, GREG L (DC)
Entity type:Individual
Prefix:DR
First Name:GREG
Middle Name:L
Last Name:KIRCHEM
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:948 NE 102ND AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-4064
Mailing Address - Country:US
Mailing Address - Phone:503-257-6036
Mailing Address - Fax:
Practice Address - Street 1:948 NE 102ND AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-4064
Practice Address - Country:US
Practice Address - Phone:503-257-6036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-17
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27 1808111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor