Provider Demographics
NPI:1174083497
Name:YOUNGS BAY CHIROPRACTIC LLC
Entity type:Organization
Organization Name:YOUNGS BAY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAMILLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BEERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-440-1303
Mailing Address - Street 1:495 OLNEY AVE
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-5524
Mailing Address - Country:US
Mailing Address - Phone:503-468-0965
Mailing Address - Fax:503-468-0931
Practice Address - Street 1:495 OLNEY AVE
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-5524
Practice Address - Country:US
Practice Address - Phone:503-468-0965
Practice Address - Fax:503-468-0931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-22
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR5856OtherOR STATE