Provider Demographics
NPI:1427234509
Name:JASMAR REDDIN D.C.,P.C.
Entity type:Organization
Organization Name:JASMAR REDDIN D.C.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JASMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:REDDIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-238-1601
Mailing Address - Street 1:11731 NE GLISAN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-2141
Mailing Address - Country:US
Mailing Address - Phone:503-238-1601
Mailing Address - Fax:503-238-1078
Practice Address - Street 1:11731 NE GLISAN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-2141
Practice Address - Country:US
Practice Address - Phone:503-238-1601
Practice Address - Fax:503-238-1078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-18
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR272239111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR112317Medicare PIN