Provider Demographics
NPI:1730239468
Name:CEDAR HILLS CHIROPRACTICS
Entity type:Organization
Organization Name:CEDAR HILLS CHIROPRACTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:INGRAM
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-526-3880
Mailing Address - Street 1:4270 SW CEDAR HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-2029
Mailing Address - Country:US
Mailing Address - Phone:503-526-3880
Mailing Address - Fax:503-526-3387
Practice Address - Street 1:4270 SW CEDAR HILLS BLVD
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-2029
Practice Address - Country:US
Practice Address - Phone:503-526-3880
Practice Address - Fax:503-526-3387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR651486111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR133964Medicare ID - Type Unspecified