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1217 Ne Burnside Rd Ste 301, Gresham, OR 97030-5705 | |
(503) 492-2625 | |
(503) 492-2355 |
Full Name | |
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Type | Facility |
Speciality | Acupuncturist |
Location | 1217 Ne Burnside Rd Ste 301, Gresham, Oregon |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
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1013289735 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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111N00000X | Chiropractor | 3243 (Oregon) | Secondary |
171100000X | Acupuncturist | AC00635 (Oregon) | Primary |
Provider Name | Daniel L Desjardins |
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Provider Type | Practitioner - Chiropractic |
Provider Identifiers | NPI Number: 1215008834 PECOS PAC ID: 4880759778 Enrollment ID: I20090210000465 |
Mailing Address | Practice Location Address |
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1217 Ne Burnside Rd, Suite 301, Gresham, OR 97030-5705 Ph: (503) 492-2625 | 1217 Ne Burnside Rd Ste 301, Gresham, OR 97030-5705 Ph: (503) 492-2625 |