Provider Demographics
NPI:1992977458
Name:BALSIGER, RICHARD MARION JR (DC)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:MARION
Last Name:BALSIGER
Suffix:JR
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 1:1019 NE 122ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-2006
Mailing Address - Country:US
Mailing Address - Phone:503-257-8606
Mailing Address - Fax:503-257-8607
Practice Address - Street 1:1019 NE 122ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-2006
Practice Address - Country:US
Practice Address - Phone:503-257-8606
Practice Address - Fax:503-257-8607
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1272111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor