Provider Demographics
NPI:1336274901
Name:BEAVERTON FAMILY CHIROPRACTIC, PC
Entity type:Organization
Organization Name:BEAVERTON FAMILY CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-644-8844
Mailing Address - Street 1:5075 SW GRIFFITH DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-2913
Mailing Address - Country:US
Mailing Address - Phone:503-644-8844
Mailing Address - Fax:503-644-8497
Practice Address - Street 1:5075 SW GRIFFITH DR
Practice Address - Street 2:SUITE 120
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-2913
Practice Address - Country:US
Practice Address - Phone:503-644-8844
Practice Address - Fax:503-644-8497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2008-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2763111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR039664Medicaid
OR108929Medicare ID - Type UnspecifiedMEDICARE ID NUMBER