| Healthsource Of Portland East | |
|
7817 Se Stark St, Portland, OR 97215-2339 | |
| (503) 376-6279 | |
| Not Available |
| Full Name | Healthsource Of Portland East |
|---|---|
| Type | Facility |
| Speciality | Chiropractor |
| Location | 7817 Se Stark St, Portland, Oregon |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396294518 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 111N00000X | Chiropractor | 5021 (Oregon) | Primary |
| Provider Name | Anthony Q Pham |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1255601258 PECOS PAC ID: 4587888920 Enrollment ID: I20140605000163 |
| Provider Name | Khashayar Jafari |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1609470046 PECOS PAC ID: 7214349679 Enrollment ID: I20201209002106 |
| Mailing Address | Practice Location Address |
|---|---|
| Healthsource Of Portland East 7817 Se Stark St, Portland, OR 97215-2339 Ph: (503) 376-6279 | Healthsource Of Portland East 7817 Se Stark St, Portland, OR 97215-2339 Ph: (503) 376-6279 |
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