Healthcare Provider Details

I. General information

NPI: 1447563010
Provider Name (Legal Business Name): JEANETTE CUMMINGS, DC, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2010
Last Update Date: 07/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 SE MORRISON STREET SUITE 1110
PORTLAND OR
97214-2390
US

IV. Provider business mailing address

516 SE MORRISON STREET SUITE 1110
PORTLAND OR
97214-2390
US

V. Phone/Fax

Practice location:
  • Phone: 503-236-9609
  • Fax: 503-236-2906
Mailing address:
  • Phone: 503-236-9609
  • Fax: 503-236-2906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2811
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number2811
License Number StateOR

VIII. Authorized Official

Name: DR. JEANETTE CUMMINGS
Title or Position: PRESIDENT
Credential:
Phone: 503-236-9609