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General NPI Number Information
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NPI Number | 1720802077
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Entity Type | Individual
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Provider Name | JORGE CHAIRES ATC, LAT
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Gender | Male
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Dates
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Enumeration Date | 11/13/2024
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 5703 N MARINE DR
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City | PORTLAND
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State | OR
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Zip | 97203-6439
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Country | US
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Telephone | 541-806-2709
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Fax |
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Provider Business Mailing Address
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Address Line | 1609 AUSTIN AVE
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City | WOODBURN
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State | OR
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Zip | 97071-6012
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Country | US
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Telephone | 541-806-2709
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT-AT-10225941
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License Number State | OR
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