Provider Demographics
NPI:1699499186
Name:HUBBARD CHIROPRACTIC CLINIC, LLC
Entity type:Organization
Organization Name:HUBBARD CHIROPRACTIC CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOLE MEMBER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:LEONARD
Authorized Official - Last Name:HUBBARD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-297-1174
Mailing Address - Street 1:PO BOX 1147
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:OR
Mailing Address - Zip Code:97140-1147
Mailing Address - Country:US
Mailing Address - Phone:503-297-1174
Mailing Address - Fax:503-297-2623
Practice Address - Street 1:10224 SW PARK WAY STE A
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5010
Practice Address - Country:US
Practice Address - Phone:503-297-1174
Practice Address - Fax:503-297-2623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-28
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty