Provider Demographics
NPI:1194752741
Name:MCNOWN, MARK JEFFREY JR (DC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:JEFFREY
Last Name:MCNOWN
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8285 SW NIMBUS AVE
Mailing Address - Street 2:STE 198
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-6447
Mailing Address - Country:US
Mailing Address - Phone:503-277-8742
Mailing Address - Fax:503-521-7960
Practice Address - Street 1:8285 SW NIMBUS AVE
Practice Address - Street 2:STE 198
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008-6447
Practice Address - Country:US
Practice Address - Phone:503-277-8742
Practice Address - Fax:503-521-7960
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR113953111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORU78268Medicare UPIN
OR113953Medicare ID - Type Unspecified