Provider Demographics
NPI:1992307904
Name:BALDAZO, LILIA (DC)
Entity type:Individual
Prefix:DR
First Name:LILIA
Middle Name:
Last Name:BALDAZO
Suffix:
Gender:
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1222 SE DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-1017
Mailing Address - Country:US
Mailing Address - Phone:503-231-9879
Mailing Address - Fax:
Practice Address - Street 1:1222 SE DIVISION ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-1017
Practice Address - Country:US
Practice Address - Phone:503-231-9879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-13
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6072111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX14491OtherCHIROPRACTIC LICENSE
OR6072OtherCHIROPRACTIC LICENSE