Provider Demographics
NPI:1043489826
Name:DRAGONHEART FAMILY HEALTHCARE, LLC
Entity type:Organization
Organization Name:DRAGONHEART FAMILY HEALTHCARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOLDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-262-8895
Mailing Address - Street 1:PO BOX 1465
Mailing Address - Street 2:
Mailing Address - City:CANNON BEACH
Mailing Address - State:OR
Mailing Address - Zip Code:97110-1465
Mailing Address - Country:US
Mailing Address - Phone:503-436-0335
Mailing Address - Fax:503-436-0604
Practice Address - Street 1:231 N HEMLOCK ST
Practice Address - Street 2:SUITE 106
Practice Address - City:CANNON BEACH
Practice Address - State:OR
Practice Address - Zip Code:97110-1465
Practice Address - Country:US
Practice Address - Phone:503-436-0335
Practice Address - Fax:503-436-0604
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DRAGONHEART FAMILY HEALTHCARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-26
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3315111N00000X
OR1590175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1063489508OtherNPI
OR1497933592OtherNPI
ORAC01274OtherAMA
OR218639Medicaid
OR182758Medicaid
ORAC01274OtherAMA