Organization
KRUSE PARK CHIROPRACTIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRONWYN ILLINGWORTH DC, MS, BS (OWNER)
(503) 593-4719
Entity
Organization
Contact information
Practice address
3990 COLLINS WAY STE 201, LAKE OSWEGO, OR 97035-3459
(503) 635-1236
Mailing address
PO BOX 1609, LAKE GROVE, OR 97035-0809
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
3897
OR
Other
Enumeration date
07/26/2018
Last updated
07/26/2018
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