| NPI | 1336577311 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TREVOR MARTIN STAUBER Owner 503-472-2111 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor Sports Physician (Licence: OR 4052) |
| Enumeration Date | 2013-10-29 |
| Last Update Date | 2020-10-27 |