Provider Demographics
NPI:1154517548
Name:ANDREW CHA D.C PC
Entity type:Organization
Organization Name:ANDREW CHA D.C PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:CHA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-260-0702
Mailing Address - Street 1:575 NE 2ND ST
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-7511
Mailing Address - Country:US
Mailing Address - Phone:503-666-4531
Mailing Address - Fax:593-665-9997
Practice Address - Street 1:575 NE 2ND ST
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-7511
Practice Address - Country:US
Practice Address - Phone:503-666-4531
Practice Address - Fax:593-665-9997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3280111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORU86-813Medicare UPIN
OR110396Medicare PIN