Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NR0400X | Rehabilitation Chiropractor | 71-3327 | OR |
Y | 111NS0005X | Chiropractic Sports Physician | 71-3327 | OR |
NPI | 1376614453 |
---|---|
Provider Name | Dr. Patrick Iaboni |
First Address | West Linn, OR 97068-4544 |
Second Address | West Linn, OR 97068-4544 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/11/2006 |
Last Update Date | 08/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
297980 | (05) | OR |