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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