Provider Demographics
NPI:1568497717
Name:PORTMANN, DOUGLAS ROSS (DC)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:ROSS
Last Name:PORTMANN
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 1:6321 PINE COVE LN
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140-5801
Mailing Address - Country:US
Mailing Address - Phone:513-697-0824
Mailing Address - Fax:
Practice Address - Street 1:550 WARDS CORNER RD
Practice Address - Street 2:SUITE 101
Practice Address - City:LOVELAND
Practice Address - State:OH
Practice Address - Zip Code:45140-6148
Practice Address - Country:US
Practice Address - Phone:513-677-6787
Practice Address - Fax:513-677-2260
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2141111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0136043Medicaid
OH0136043Medicaid
OH9329461Medicare ID - Type UnspecifiedGROUP MEDICARE