Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 2355 | OR |
NPI | 1003947797 |
---|---|
Provider Name | Dr. Marelle O'meara |
First Address | Portland, OR 97204-3117 |
Second Address | Portland, OR 97204-3117 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2007 |
Last Update Date | 16/04/2015 |