Provider Demographics
NPI:1588079776
Name:FUNCTION PERFORMANCE SPORT CHIROPRACTIC LLC
Entity type:Organization
Organization Name:FUNCTION PERFORMANCE SPORT CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:BEN
Authorized Official - Middle Name:AARON
Authorized Official - Last Name:HOKENSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-730-2788
Mailing Address - Street 1:502 7TH ST
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-2246
Mailing Address - Country:US
Mailing Address - Phone:503-730-7888
Mailing Address - Fax:503-862-5043
Practice Address - Street 1:502 7TH ST STE 100
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-2246
Practice Address - Country:US
Practice Address - Phone:503-730-2788
Practice Address - Fax:503-862-5043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-25
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3898111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR155561Medicare PIN