Provider Demographics
NPI:1487942215
Name:OREGON TRAIL CHIROPRACTIC LLC
Entity type:Organization
Organization Name:OREGON TRAIL CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:RHUE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-201-7532
Mailing Address - Street 1:PO BOX 909
Mailing Address - Street 2:
Mailing Address - City:BORING
Mailing Address - State:OR
Mailing Address - Zip Code:97009-0909
Mailing Address - Country:US
Mailing Address - Phone:503-630-4037
Mailing Address - Fax:503-630-5636
Practice Address - Street 1:437 NE MAIN ST
Practice Address - Street 2:
Practice Address - City:ESTACADA
Practice Address - State:OR
Practice Address - Zip Code:97023-8528
Practice Address - Country:US
Practice Address - Phone:503-630-4037
Practice Address - Fax:503-630-5636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-13
Last Update Date:2023-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4059111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty