Provider Demographics
NPI:1962606178
Name:DOLPHIN CHIROPRACTIC & ORTHOPEDIC PHYSICAL THERAPY CENTER, LLC
Entity type:Organization
Organization Name:DOLPHIN CHIROPRACTIC & ORTHOPEDIC PHYSICAL THERAPY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIVEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:DONATO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-664-5151
Mailing Address - Street 1:1208 BEALL LN
Mailing Address - Street 2:
Mailing Address - City:CENTRAL POINT
Mailing Address - State:OR
Mailing Address - Zip Code:97502-1573
Mailing Address - Country:US
Mailing Address - Phone:541-664-5151
Mailing Address - Fax:541-664-5155
Practice Address - Street 1:1314 CENTER DR
Practice Address - Street 2:SUITE 14
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-7908
Practice Address - Country:US
Practice Address - Phone:541-857-2678
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR273291111N00000X
OR41972251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR109990Medicare PIN