Healthcare Provider Details

I. General information

NPI: 1194752741
Provider Name (Legal Business Name): MARK JEFFREY MCNOWN JR. D.C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 06/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8285 SW NIMBUS AVE STE 198
BEAVERTON OR
97008-6447
US

IV. Provider business mailing address

8285 SW NIMBUS AVE STE 198
BEAVERTON OR
97008-6447
US

V. Phone/Fax

Practice location:
  • Phone: 503-277-8742
  • Fax: 503-521-7960
Mailing address:
  • Phone: 503-277-8742
  • Fax: 503-521-7960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number113953
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: