Provider Demographics
NPI:1588907570
Name:OLTMANN, GREGORY ALAN (DC)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:ALAN
Last Name:OLTMANN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4055 SW 185TH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97007-1567
Mailing Address - Country:US
Mailing Address - Phone:503-642-1449
Mailing Address - Fax:503-642-1577
Practice Address - Street 1:12700 SW NORTH DAKOTA ST STE 180
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-0802
Practice Address - Country:US
Practice Address - Phone:503-716-8281
Practice Address - Fax:037-168-7835
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-28
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5138111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor