Provider Demographics
NPI:1194156349
Name:ASTORIA CHIROPRACTIC PHYSICIANS CENTER
Entity type:Organization
Organization Name:ASTORIA CHIROPRACTIC PHYSICIANS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDEEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-791-4611
Mailing Address - Street 1:2935 MARINE DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-2831
Mailing Address - Country:US
Mailing Address - Phone:503-325-3311
Mailing Address - Fax:503-325-9135
Practice Address - Street 1:2935 MARINE DR
Practice Address - Street 2:SUITE B
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-2831
Practice Address - Country:US
Practice Address - Phone:503-325-3311
Practice Address - Fax:503-325-9135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-12
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty