Provider Demographics
NPI:1174564934
Name:MILWAUKIE CHIROPRACTIC CENTER
Entity type:Organization
Organization Name:MILWAUKIE CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:D
Authorized Official - Last Name:JOHNS
Authorized Official - Suffix:
Authorized Official - Credentials:DC PC
Authorized Official - Phone:503-659-0073
Mailing Address - Street 1:3716 SE INTERNATIONAL WAY
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222
Mailing Address - Country:US
Mailing Address - Phone:503-659-0073
Mailing Address - Fax:503-659-7471
Practice Address - Street 1:3716 SE INTERNATIONAL WAY
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222
Practice Address - Country:US
Practice Address - Phone:503-659-0073
Practice Address - Fax:503-659-7471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
825279001OtherREGENCE BLUE CROSS
370939OtherAMERICAN SPECIALTY HEALTH
117094OtherKAISER PERMANENTE PC
30176OtherWASHINGTON DEPT OF LABOR
825279000OtherBLUE CROSS BLUE SHIELD
85120066620630OtherREGENCE LIFE & HEALTH
117094OtherKAISER PERMANENTE PC
825279001OtherREGENCE BLUE CROSS