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Organization
LIFESTREAMS CHIROPRACTIC CENTER, LLC
Active
Organization
LIFESTREAMS CHIROPRACTIC CENTER, LLC
Active
Other names
Mary Ann Tack, DC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARY ANN TACK DC (CHIROPRACTOR/OWNER)
(503) 537-2052
Entity
Organization
Contact information
Practice address
901 BRUTSCHER ST STE 210, NEWBERG, OR 97132-6094
(503) 537-2052
(503) 538-8315
Mailing address
901 BRUTSCHER ST STE 210, NEWBERG, OR 97132-6094
(503) 537-2052
(503) 538-8315
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
—
261Q00000X
Clinic/Center
2863
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000QGHFP
MEDICARE ID TYPE UNSPECIFIED
OR
05
—
274833
—
OR
Enumeration date
07/27/2011
Last updated
06/19/2020
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