Provider Demographics
NPI:1285704718
Name:COHEN, ABRAHAM J (DC)
Entity type:Individual
Prefix:
First Name:ABRAHAM
Middle Name:J
Last Name:COHEN
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 1:823 NE BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1215
Mailing Address - Country:US
Mailing Address - Phone:503-288-5257
Mailing Address - Fax:503-282-9869
Practice Address - Street 1:823 NE BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1215
Practice Address - Country:US
Practice Address - Phone:503-288-5257
Practice Address - Fax:503-282-9869
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27-1471111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORU54469Medicare UPIN