Provider Demographics
NPI:1154800894
Name:HAN, JAY (DC)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:
Last Name:HAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8733 SE DIVISION ST STE 209
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266-1470
Mailing Address - Country:US
Mailing Address - Phone:503-334-7943
Mailing Address - Fax:
Practice Address - Street 1:8733 SE DIVISION ST STE 209
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97266-1470
Practice Address - Country:US
Practice Address - Phone:503-334-7943
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-13
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5928111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor