Provider Demographics
NPI:1679979397
Name:CORRECTIVE STEP FOOT HEALTH CENTER
Entity type:Organization
Organization Name:CORRECTIVE STEP FOOT HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EJIRO
Authorized Official - Middle Name:C
Authorized Official - Last Name:ISIORHO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:503-624-0364
Mailing Address - Street 1:11515 SW DURHAM RD
Mailing Address - Street 2:E1
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-3476
Mailing Address - Country:US
Mailing Address - Phone:503-624-0364
Mailing Address - Fax:503-684-3306
Practice Address - Street 1:11515 SW DURHAM RD
Practice Address - Street 2:E1
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224-3476
Practice Address - Country:US
Practice Address - Phone:503-624-0364
Practice Address - Fax:503-684-3306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-06
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDP161832213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty