Individual provider · Type 1 NPI
Michael D. Raeburn, D.C, CCSP
Chiropractor · Portland, OR
NPI number
1366644114
Active
Practice location
2064 N Killingsworth St
Portland, OR 97217-4439
Fax (503) 719-7571
Mailing address
2064 N. Killlingsworth St
Portland, OR 97217-4439
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Chiropractor Primary | 111N00000X | 273652 (OR) |
Chiropractor: A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems.
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About NPI 1366644114
Michael D. Raeburn, D.C, CCSP's National Provider Identifier is 1366644114, issued on Jun 4, 2007. The primary taxonomy on file is Chiropractor (111N00000X), and the practice location is in Portland, OR. The record was last updated on Aug 4, 2010.