Provider Demographics
NPI:1316488356
Name:CHEA, JIM (CPO)
Entity type:Individual
Prefix:MR
First Name:JIM
Middle Name:
Last Name:CHEA
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11782 SW BARNES RD STE 160E
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-5939
Mailing Address - Country:US
Mailing Address - Phone:503-641-2020
Mailing Address - Fax:503-574-3274
Practice Address - Street 1:11782 SW BARNES RD STE 160E
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5939
Practice Address - Country:US
Practice Address - Phone:503-641-2020
Practice Address - Fax:503-574-3274
Is Sole Proprietor?:No
Enumeration Date:2017-03-09
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist