Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 5701 | OR |
NPI | 1265897623 |
---|---|
Provider Name | Ajay Iselin |
First Address | Beaverton, OR 97005-5607 |
Second Address | Beaverton, OR 97005-5607 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2015 |
Last Update Date | 29/12/2015 |