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NPI Code Detail

MEDICARE: JADE CHIROPRACTIC PC

MEDICARE: JADE CHIROPRACTIC PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractor3992OR

General Provider Information

NPI Number : 1881972685
Entity Type Code : Organization
Provider Name (Legal Business Name) : JADE CHIROPRACTIC PC
Provider Business Mailing Address
First Line : 5517 N COMMERCIAL AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97217-2339
Country : US
Telephone Number : 503-223-0900
Fax Number :
Provider Business Practice Location Address
First Line : 5517 N COMMERCIAL AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97217-2339
Country : US
Telephone Number : 503-223-0900
Fax Number :
Authorized Official
Title or Position : OWNER, CHIROPRACTOR
Name : DR. MOLLY OUELLETTE
Credential : DC
Telephone Number : 339-707-0806
Provider Enumeration Date : 07/27/2011
Last Update Date : 04/22/2014

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Directions to “JADE CHIROPRACTIC PC ” Practice Location

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