Provider Demographics
NPI:1053541938
Name:CMCDONOUGH CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:CMCDONOUGH CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:BRIDGET
Authorized Official - Last Name:MCDONOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-485-0830
Mailing Address - Street 1:358 SUPERIOR ST SE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-5170
Mailing Address - Country:US
Mailing Address - Phone:503-485-0830
Mailing Address - Fax:503-485-0831
Practice Address - Street 1:358 SUPERIOR ST SE
Practice Address - Street 2:SUITE 100
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-5170
Practice Address - Country:US
Practice Address - Phone:503-485-0830
Practice Address - Fax:503-485-0831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-25
Last Update Date:2009-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2948261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR118518Medicare PIN