Provider Demographics
NPI:1215913637
Name:VROOM, BRIAN LAURIE (DC)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:LAURIE
Last Name:VROOM
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:837 E POWELL BLVD
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-7617
Mailing Address - Country:US
Mailing Address - Phone:503-669-9495
Mailing Address - Fax:503-669-8257
Practice Address - Street 1:837 E POWELL BLVD
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-7617
Practice Address - Country:US
Practice Address - Phone:503-669-9495
Practice Address - Fax:503-669-8257
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR272936111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor