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Organization
CHIROPRACTIC LIFE CENTER PC
Active
Organization
CHIROPRACTIC LIFE CENTER PC
Active
Other names
Chiropractic Life Center
Organization subpart
No
Provider details
NPI number
Authorized official
MARK RONALD JOHANSEN DC (OWNER)
(503) 255-7746
Entity
Organization
Contact information
Practice address
12762 SE STARK ST, PLAZA 125, BLDG D, PORTLAND, OR 97233-1539
(503) 255-7746
(503) 255-0818
Mailing address
12762 SE STARK ST, PLAZA 125, BLDG D, PORTLAND, OR 97233-1539
(503) 255-7746
(503) 255-0818
Taxonomy
Speciality
Code
Description
License number
State
111NX0800X
Orthopedic Chiropractor
Primary
271737
OR
Other
Enumeration date
04/04/2008
Last updated
08/01/2019
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