Organization
NORTHWEST SPINE AND SPORT LLC
Active
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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