Organization
LIFESTREAMS CHIROPRACTIC CENTER, LLC
Active
Other names
Mary Ann Tack, DC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARY ANN TACK DC (CHIROPRACTOR/OWNER)
(503) 537-2052
Entity
Organization
Contact information
Practice address
901 BRUTSCHER ST STE 210, NEWBERG, OR 97132-6094
(503) 537-2052
(503) 538-8315
Mailing address
901 BRUTSCHER ST STE 210, NEWBERG, OR 97132-6094
(503) 537-2052
(503) 538-8315
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
—
261Q00000X
Clinic/Center
2863
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000QGHFP
MEDICARE ID TYPE UNSPECIFIED
OR
05
—
274833
—
OR
Enumeration date
07/27/2011
Last updated
06/19/2020
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