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General NPI Number Information
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NPI Number | 1437930963
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Entity Type | Individual
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Provider Name | JONATHAN KEVIN CRUZ DC
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Gender | Male
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Dates
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Enumeration Date | 10/10/2023
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Last Update Date | 11/28/2023
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Provider Practice Location Address
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Address Line | 4847 MEADOWS RD STE 153
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City | LAKE OSWEGO
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State | OR
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Zip | 97035-2626
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Country | US
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Telephone | 971-330-8578
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Fax |
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Provider Business Mailing Address
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Address Line | 1905 MAIN ST APT 302
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City | OREGON CITY
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State | OR
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Zip | 97045-1074
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Country | US
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Telephone | 541-232-6479
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 6335
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License Number State | OR
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