Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 272916 | OR |
N | 111NN0400X | Neurology | 272916 | OR |
NPI | 1053411041 |
---|---|
Provider Name | Dr. Brian Denis Mchale |
First Address | Oregon City, OR 97045-2346 |
Second Address | Oregon City, OR 97045-2346 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2006 |
Last Update Date | 01/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0104061 | WASHINGTON ST WORK COMP (01) | OR |
931184440 | TAX ID (01) | OR |
U58244 | (02) |