Provider Demographics
NPI:1962559625
Name:SORAH, MICHAEL WADE (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:WADE
Last Name:SORAH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:999 NW CIRCLE BLVD
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-1408
Mailing Address - Country:US
Mailing Address - Phone:541-754-2225
Mailing Address - Fax:541-752-9086
Practice Address - Street 1:999 NW CIRCLE BLVD
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-1408
Practice Address - Country:US
Practice Address - Phone:541-754-2225
Practice Address - Fax:541-752-9086
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27 2949111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0000QGHFYMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER