Organization
PORTLAND SPINE CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THEODORE ROBERT LILLIE D.C. (OWNER)
(503) 282-7581
Entity
Organization
Contact information
Practice address
2106 NE 47TH AVE, PORTLAND, OR 97213-2064
(503) 282-7581
Mailing address
2106 NE 47TH AVE, PORTLAND, OR 97213-2064
(503) 282-7581
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
5123
OR
Other
Enumeration date
05/20/2014
Last updated
05/20/2014
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