Provider Demographics
NPI:1902536485
Name:ABRAHAMSON CHIROPRACTIC AND WELLNESS OF PORTLAND
Entity type:Organization
Organization Name:ABRAHAMSON CHIROPRACTIC AND WELLNESS OF PORTLAND
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ABRAHAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:615-826-7889
Mailing Address - Street 1:826 S BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:TN
Mailing Address - Zip Code:37148-1622
Mailing Address - Country:US
Mailing Address - Phone:615-826-7889
Mailing Address - Fax:
Practice Address - Street 1:826 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:TN
Practice Address - Zip Code:37148-1622
Practice Address - Country:US
Practice Address - Phone:615-826-7889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ABRAHAMSON CHIROPRACTIC AND WELLNESS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-06-16
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty