Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 5078 | OR |
NPI | 1154669711 |
---|---|
Provider Name | Dr. Solon Chase Gentry |
First Address | Woodburn, OR 97071-3674 |
Second Address | Woodburn, OR 97071-3674 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2013 |
Last Update Date | 16/01/2013 |