Provider Demographics
NPI:1124790795
Name:CEDAR MILL FAMILY CHIROPRACTIC INC
Entity type:Organization
Organization Name:CEDAR MILL FAMILY CHIROPRACTIC INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:CHRISTY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:541-410-6776
Mailing Address - Street 1:12923 NW CORNELL RD STE 201
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-5834
Mailing Address - Country:US
Mailing Address - Phone:503-646-3393
Mailing Address - Fax:
Practice Address - Street 1:12923 NW CORNELL RD STE 201
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-5834
Practice Address - Country:US
Practice Address - Phone:503-646-3393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-01
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty