Provider Demographics
NPI:1962558320
Name:MOHR, ADAM GARRETT (DC, CCSP)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:GARRETT
Last Name:MOHR
Suffix:
Gender:M
Credentials:DC, CCSP
Other - Prefix:DR
Other - First Name:ADAM
Other - Middle Name:GARRETT
Other - Last Name:ZINN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC, CCSP
Mailing Address - Street 1:11545 SW DURHAM RD
Mailing Address - Street 2:SUITE B-9
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-3473
Mailing Address - Country:US
Mailing Address - Phone:503-639-0778
Mailing Address - Fax:503-639-0815
Practice Address - Street 1:11545 SW DURHAM RD
Practice Address - Street 2:SUITE B-9
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224-3473
Practice Address - Country:US
Practice Address - Phone:503-639-0778
Practice Address - Fax:503-639-0815
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3703111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor