Provider Demographics
NPI:1154600567
Name:C AND C CHIROPRACTIC
Entity type:Organization
Organization Name:C AND C CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:ESTELA
Authorized Official - Last Name:MANDUJANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-617-0906
Mailing Address - Street 1:17200 NW CORRIDOR CT
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-3295
Mailing Address - Country:US
Mailing Address - Phone:503-617-0906
Mailing Address - Fax:503-617-0949
Practice Address - Street 1:17200 NW CORRIDOR CT
Practice Address - Street 2:SUITE 100
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-3295
Practice Address - Country:US
Practice Address - Phone:503-617-0906
Practice Address - Fax:503-617-0949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-16
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3215111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1043381593OtherINDIVIDUAL NPI