Organization
KELSALL CHIROPRACTIC CLINIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMY BURGESS OFFICE MANAGER (OFFICE MANAGER)
(503) 223-8719
Entity
Organization
Contact information
Practice address
1615 NW 23RD AVE, SUITE 2, PORTLAND, OR 97210-2563
(503) 223-8719
(503) 223-3237
Mailing address
1615 NW 23RD AVE, SUITE 2, PORTLAND, OR 97210-2563
(503) 223-8719
(503) 223-3237
Taxonomy
Speciality
Code
Description
License number
State
111NS0005X
Sports Physician Chiropractor
Primary
2997
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R100924
MEDICARE PROVIDER ID
—
Enumeration date
06/26/2008
Last updated
06/26/2008
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