Provider Demographics
NPI:1902945272
Name:ALLIANCE CLINIC, PC
Entity Type:Organization
Organization Name:ALLIANCE CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEIGNA
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITNEY
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:503-288-5857
Mailing Address - Street 1:5257 NE MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-3282
Mailing Address - Country:US
Mailing Address - Phone:503-288-5857
Mailing Address - Fax:503-288-1216
Practice Address - Street 1:5257 NE MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:SUITE 303
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-3282
Practice Address - Country:US
Practice Address - Phone:503-288-5857
Practice Address - Fax:503-288-1216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR8242225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty