Provider Demographics
NPI:1346407244
Name:LEAVITT CHIROPRACTIC LLC
Entity type:Organization
Organization Name:LEAVITT CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:HUGH
Authorized Official - Last Name:LEAVITT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-816-2184
Mailing Address - Street 1:1706 NW GLISAN ST STE 5
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-2225
Mailing Address - Country:US
Mailing Address - Phone:503-228-5000
Mailing Address - Fax:503-228-5019
Practice Address - Street 1:1706 NW GLISAN ST STE 5
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-2225
Practice Address - Country:US
Practice Address - Phone:503-228-5000
Practice Address - Fax:503-228-5019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR273413261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service