Provider Demographics
NPI:1538395520
Name:BERNTSEN CHIROPRACTIC P C
Entity type:Organization
Organization Name:BERNTSEN CHIROPRACTIC P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:S
Authorized Official - Last Name:BERNTSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-253-9957
Mailing Address - Street 1:336 NE 102ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-4107
Mailing Address - Country:US
Mailing Address - Phone:503-253-9957
Mailing Address - Fax:503-253-6309
Practice Address - Street 1:336 NE 102ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-4107
Practice Address - Country:US
Practice Address - Phone:503-253-9957
Practice Address - Fax:503-253-6309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2399111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty