Healthcare Provider Details

I. General information

NPI: 1134066921
Provider Name (Legal Business Name): HIGH DESERT SPINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

813 SW HIGHLAND AVE STE 103
REDMOND OR
97756-3103
US

IV. Provider business mailing address

813 SW HIGHLAND AVE STE 103
REDMOND OR
97756-3103
US

V. Phone/Fax

Practice location:
  • Phone: 541-516-0060
  • Fax: 541-981-5139
Mailing address:
  • Phone: 541-516-0060
  • Fax: 541-981-5139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. JACOB A HERNANDEZ
Title or Position: DOCTOR OF CHIROPRACTIC
Credential: DC
Phone: 541-516-0060