Provider Demographics
NPI:1992068225
Name:ULTRA CHIROPRACTIC AND REHABILITATION, LLC
Entity type:Organization
Organization Name:ULTRA CHIROPRACTIC AND REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:LEEANN
Authorized Official - Last Name:ZETTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-347-8988
Mailing Address - Street 1:1977 NW OVERTON ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-1618
Mailing Address - Country:US
Mailing Address - Phone:503-208-4084
Mailing Address - Fax:503-223-1222
Practice Address - Street 1:1977 NW OVERTON ST
Practice Address - Street 2:SUITE C
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-2339
Practice Address - Country:US
Practice Address - Phone:503-208-4085
Practice Address - Fax:503-223-1222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-21
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5030111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty