Provider Demographics
NPI:1689897548
Name:BAINS, PRABHJOT KAUR (DC)
Entity type:Individual
Prefix:DR
First Name:PRABHJOT
Middle Name:KAUR
Last Name:BAINS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:JOTY
Other - Middle Name:KAUR
Other - Last Name:BAINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 3160
Mailing Address - Street 2:
Mailing Address - City:CENTRAL POINT
Mailing Address - State:OR
Mailing Address - Zip Code:97502-0006
Mailing Address - Country:US
Mailing Address - Phone:541-414-0362
Mailing Address - Fax:541-200-2269
Practice Address - Street 1:2931 DOCTORS PARK DR
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504
Practice Address - Country:US
Practice Address - Phone:541-245-4444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR273538111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR856434002OtherBLUE CROSS OF OREGON
OR500628529Medicaid
ORJ011401OtherPACIFIC SOURCE