Provider Demographics
NPI:1194983445
Name:WILLIAM A ECONE DC PC
Entity type:Organization
Organization Name:WILLIAM A ECONE DC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BETSY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MITCHELLDYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-203-6855
Mailing Address - Street 1:9450 SW BARNES RD STE 280
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-6673
Mailing Address - Country:US
Mailing Address - Phone:503-203-6855
Mailing Address - Fax:503-206-6922
Practice Address - Street 1:9450 SW BARNES RD STE 280
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6673
Practice Address - Country:US
Practice Address - Phone:503-203-6855
Practice Address - Fax:503-206-6922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27 2288111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty