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Interstate Medical Group Llc
Medical Specialty Clinic/Center in Portland, Oregon
NPI 1932839776

Interstate Medical Group Llc is a Medical Specialty Clinic/Center based in Portland, OR and is specialized in Medical Specialty. Interstate Medical Group Llc practices in Portland, OR. The NPI Number for Interstate Medical Group Llc is 1932839776 and holds a License No. (Oregon).

The current practice location address for Interstate Medical Group Llc is 17221 Se Division St, Portland, OR and can be reached out via phone at 503-760-0778 and via fax at 503-760-0753.

Location: 17221 Se Division St, Portland, OR, 97236-1240
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1932839776
Provider Name
Interstate Medical Group Llc
Credential
Provider Entity Type
Organization
Address
17221 Se Division St, Portland, OR, 97236-1240
Phone Number
503-760-0778
Fax Number
503-760-0753
Provider Enumeration Date
06/14/2022
Last Update Date
03/13/2024
institution
Provider Business Practice Location Address Details
Address
17221 Se Division St
City
Portland
State
Oregon
Zip
97236-1240
Phone Number
503-760-0778
Fax Number
503-760-0753
person
Provider Business Mailing Address Details
Address
17221 Se Division St
City
Portland
State
Oregon
Zip
97236-1240
Phone Number
503-760-0778
Fax Number
503-760-0753
person
Provider's Taxonomy Details 1
Type
Chiropractic Providers
Classification
Chiropractor
Speciality
-
Taxonomy
111N00000X
License No.
()
Definition
A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems.
person
Provider's Taxonomy Details 2
Type
Respiratory, Developmental, Rehabilitative and Restorative Service Providers
Classification
Massage Therapist
Speciality
-
Taxonomy
225700000X
License No.
()
Definition
An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes.
person
Provider's Taxonomy Details 3
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Multi-Specialty
Taxonomy
261QM1300X
License No.
()
Definition
Definition to come...
person
Provider's Taxonomy Details 4
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Medical Specialty
Taxonomy
261QM2500X
License No.
()
Definition
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer).
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