Provider Demographics
NPI:1215074737
Name:KERR, LAURA JEAN (DC)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:JEAN
Last Name:KERR
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1318 NW 20TH AVE
Mailing Address - Street 2:STE 5A
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-1671
Mailing Address - Country:US
Mailing Address - Phone:541-913-8300
Mailing Address - Fax:541-284-7335
Practice Address - Street 1:1318 NW 20TH AVE
Practice Address - Street 2:STE 5A
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-1671
Practice Address - Country:US
Practice Address - Phone:503-741-9285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2017-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27 3523111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR26-4188992OtherIRS EIN