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General NPI Number Information
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NPI Number | 1770834558
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Entity Type | Individual
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Provider Name | JESSICA SKYE CALLAHAN
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Gender | Female
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Dates
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Enumeration Date | 09/20/2012
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Last Update Date | 09/20/2012
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Provider Practice Location Address
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Address Line | 1750 BLANKENSHIP RD SUITE 295
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City | WEST LINN
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State | OR
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Zip | 97068-5101
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Country | US
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Telephone | 503-344-4378
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Fax |
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Provider Business Mailing Address
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Address Line | 315 HIGH STREET APT 308
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City | OREGON CITY
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State | OR
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Zip | 97045
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Country | US
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Telephone | 503-344-4378
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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 | 17764
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License Number State | OR
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