Provider Demographics
NPI:1194911743
Name:CAFE OF LIFE CHIROPRACTIC PC
Entity type:Organization
Organization Name:CAFE OF LIFE CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:BOORSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:541-389-3894
Mailing Address - Street 1:519 NW COLORADO AVE
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-3216
Mailing Address - Country:US
Mailing Address - Phone:541-389-3894
Mailing Address - Fax:541-389-5004
Practice Address - Street 1:519 NW COLORADO AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-3216
Practice Address - Country:US
Practice Address - Phone:541-389-3894
Practice Address - Fax:541-389-5004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR273340111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty