Organization
ACTIVE CHIROPRACTIC AND REHABILITATION, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PATRICK D BOURLON DC (OWNER/SOLE MEMBER)
(503) 648-1088
Entity
Organization
Contact information
Practice address
238 SE WASHINGTON ST STE B, HILLSBORO, OR 97123-4279
(503) 648-1088
(503) 648-0748
Mailing address
238 SE WASHINGTON ST STE B, HILLSBORO, OR 97123-4279
(503) 648-1088
(503) 648-0748
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0147111
WASHINGTON STATE LABOR
WA
01
—
023051002
BLUE CROSS
OR
Enumeration date
08/13/2010
Last updated
08/13/2010
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