Organization
MODERN CHIROPRACTIC, LLC
Active
Other names
Modern Chiropractic
Organization subpart
No
Provider details
NPI number
Authorized official
PHILIP DEVASTO DC (OWNER)
(617) 365-1527
Entity
Organization
Contact information
Practice address
16679 BOONES FERRY RD STE 105, LAKE OSWEGO, OR 97035-4378
(503) 635-6005
Mailing address
16679 BOONES FERRY RD STE 105, LAKE OSWEGO, OR 97035-4378
(503) 635-6005
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
—
Other
Enumeration date
11/15/2023
Last updated
11/15/2023
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