Provider Demographics
NPI:1285706150
Name:TOMLIN, JAI D (DC)
Entity type:Individual
Prefix:MS
First Name:JAI
Middle Name:D
Last Name:TOMLIN
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 1:344 SW 7TH ST
Mailing Address - Street 2:STE D
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365
Mailing Address - Country:US
Mailing Address - Phone:541-265-9218
Mailing Address - Fax:541-265-3953
Practice Address - Street 1:344 SW 7TH ST
Practice Address - Street 2:STE D
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365
Practice Address - Country:US
Practice Address - Phone:541-265-9218
Practice Address - Fax:541-265-3953
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR272678111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR035050Medicaid
U25162Medicare UPIN
OR035050Medicaid