Provider Demographics
NPI:1053584995
Name:DEWAR, DAVID ALAN (DC)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ALAN
Last Name:DEWAR
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1385 SE 1ST AVE. SUITE 102
Mailing Address - Street 2:
Mailing Address - City:CANBY
Mailing Address - State:OR
Mailing Address - Zip Code:97013-6767
Mailing Address - Country:US
Mailing Address - Phone:503-266-0600
Mailing Address - Fax:503-766-5703
Practice Address - Street 1:1385 1ST AVE. SUITE 102
Practice Address - Street 2:
Practice Address - City:CANBY
Practice Address - State:OR
Practice Address - Zip Code:97013-6767
Practice Address - Country:US
Practice Address - Phone:503-266-0600
Practice Address - Fax:503-766-5703
Is Sole Proprietor?:No
Enumeration Date:2008-04-11
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3831111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
R16110Medicare UPIN
ORR161110Medicare UPIN