Provider Demographics
NPI:1386715548
Name:STUART, SAMANTHA E (DC)
Entity type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:E
Last Name:STUART
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4845 SE VINTAGE PL
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97267-5961
Mailing Address - Country:US
Mailing Address - Phone:503-320-8542
Mailing Address - Fax:
Practice Address - Street 1:11657 NE GLISAN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-2264
Practice Address - Country:US
Practice Address - Phone:503-252-3560
Practice Address - Fax:503-252-3199
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR273420111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor