| Powell Valley Chiropractic Clinic | |
|
4253 Se 182nd Ave Gresham OR 97030-5083 | |
| (503) 661-5090 | |
| Not Available |
| Full Name | Powell Valley Chiropractic Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 4253 Se 182nd Ave, Gresham, Oregon |
| Authorized Official Name and Position | Michael Robert Whitaker (MEMBER) |
| Authorized Official Contact | 5036615090 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Powell Valley Chiropractic Clinic 4253 Se 182nd Ave Gresham OR 97030-5083 Ph: (503) 661-5090 | Powell Valley Chiropractic Clinic 4253 Se 182nd Ave Gresham OR 97030-5083 Ph: (503) 661-5090 |
| NPI Number | 1831641505 |
|---|---|
| Provider Enumeration Date | 10/28/2016 |
| Last Update Date | 10/28/2016 |
| Medicare PECOS PAC ID | 6103107313 |
|---|---|
| Medicare Enrollment ID | O20161230001167 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831641505 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 5545 (Oregon) | Primary |
| Provider Name | Michael Whitaker |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1689097503 PECOS PAC ID: 7517247612 Enrollment ID: I20161230001234 |
| Provider Name | David S Rief |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1255880316 PECOS PAC ID: 4688094691 Enrollment ID: I20201013002243 |
| Provider Name | Meghan Trebilco |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1235882416 PECOS PAC ID: 2062807068 Enrollment ID: I20220309001368 |
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