Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 4017 | OR |
N | 111NN0400X | Neurology | OR4017 | OR |
NPI | 1407119605 |
---|---|
Provider Name | Dr. Joseph Elias Vance |
First Address | Portland, OR 97219-3220 |
Second Address | Beaverton, OR 97005-0530 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2012 |
Last Update Date | 04/08/2021 |