Healthcare Provider Details

I. General information

NPI: 1386866424
Provider Name (Legal Business Name): JAYLENE LEWIS D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 06/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1895 NW 188TH AVE
HILLSBORO OR
97006-6485
US

IV. Provider business mailing address

1895 NW 188TH AVE
HILLSBORO OR
97006-6485
US

V. Phone/Fax

Practice location:
  • Phone: 503-718-7161
  • Fax: 503-268-1691
Mailing address:
  • Phone: 503-718-7161
  • Fax: 503-268-1691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3354
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number14086
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number23298
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: