Organization
THE SPARK OF LIFE INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RANDALL L. FISH D.C. (OWNER/CEO)
(503) 595-1717
Entity
Organization
Contact information
Practice address
9900 SW WILSHIRE ST, STE 170, PORTLAND, OR 97225-5035
(503) 595-1717
(503) 595-1719
Mailing address
9900 SW WILSHIRE ST, STE 170, PORTLAND, OR 97225-5035
(503) 595-1717
(503) 595-1719
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
273520
OR
Other
Enumeration date
11/07/2007
Last updated
08/12/2008
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