Healthcare Provider Details

I. General information

NPI: 1578835211
Provider Name (Legal Business Name): JAN CORWIN, DC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2012
Last Update Date: 01/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 NE 28TH AVE
PORTLAND OR
97232-3150
US

IV. Provider business mailing address

316 NE 28TH AVE
PORTLAND OR
97232-3150
US

V. Phone/Fax

Practice location:
  • Phone: 503-230-0812
  • Fax:
Mailing address:
  • Phone: 503-230-0812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number1658
License Number StateOR

VIII. Authorized Official

Name: DR. JAN CORWIN
Title or Position: OWNER
Credential: DC
Phone: 503-230-0812