Organization
NORTHWEST SPINE AND SPORT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TREVOR MARTIN STAUBER DC, MS, CCSP (OWNER)
(503) 472-2111
Entity
Organization
Contact information
Practice address
850 SW BOOTH BEND RD, MCMINNVILLE, OR 97128-9320
(503) 472-2111
(503) 434-5886
Mailing address
850 SW BOOTH BEND RD, MCMINNVILLE, OR 97128-9320
(503) 472-2111
(503) 434-5886
Taxonomy
Speciality
Code
Description
License number
State
111NS0005X
Sports Physician Chiropractor
Primary
4052
OR
Other
Enumeration date
10/29/2013
Last updated
10/27/2020
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