Healthcare Provider Details

I. General information

NPI: 1942773049
Provider Name (Legal Business Name): JACOB JAMES DEARTON DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2019
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 EXECUTIVE PKWY STE 340
EUGENE OR
97401-2169
US

IV. Provider business mailing address

1200 EXECUTIVE PKWY STE 340
EUGENE OR
97401-2169
US

V. Phone/Fax

Practice location:
  • Phone: 541-345-1669
  • Fax: 541-972-4433
Mailing address:
  • Phone: 541-345-1669
  • Fax: 541-972-4433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6319
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: