Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 272948 | OR |
NPI | 1073674289 |
---|---|
Provider Name | Dr. Colleen Bridget Mcdonough |
First Address | Salem, OR 97302-5170 |
Second Address | Salem, OR 97302-5170 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2006 |
Last Update Date | 08/07/2007 |