Organization
THE SPARK OF LIFE CHIROPRACTIC & WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RANDALL L FISH D.C. (OWNER)
(503) 654-5433
Entity
Organization
Contact information
Practice address
2025 SE JEFFERSON ST, MILWAUKIE, OR 97222-7605
(503) 654-5433
(503) 654-5439
Mailing address
2025 SE JEFFERSON ST, MILWAUKIE, OR 97222-7605
(503) 654-5433
(503) 654-5439
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
273520
OR
Other
Enumeration date
12/21/2007
Last updated
12/21/2007
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