Provider Demographics
NPI:1053607721
Name:ACCIDENT AND WELLNESS CHIROPRACTIC LLC
Entity type:Organization
Organization Name:ACCIDENT AND WELLNESS CHIROPRACTIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THUNGA
Authorized Official - Middle Name:LINA
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-992-6080
Mailing Address - Street 1:6035 SW 185TH AVE
Mailing Address - Street 2:
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97007-4551
Mailing Address - Country:US
Mailing Address - Phone:503-992-6080
Mailing Address - Fax:503-992-6081
Practice Address - Street 1:6035 SW 185TH AVE
Practice Address - Street 2:
Practice Address - City:ALOHA
Practice Address - State:OR
Practice Address - Zip Code:97007-4551
Practice Address - Country:US
Practice Address - Phone:503-992-6080
Practice Address - Fax:503-992-6081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-21
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3866302R00000X, 305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
No302R00000XManaged Care OrganizationsHealth Maintenance Organization