Provider Demographics
NPI:1487608147
Name:FLETCHER, JENNIFER ANN (DC, LAC)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ANN
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:0224 SW HAMILTON ST STE 101
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-6418
Mailing Address - Country:US
Mailing Address - Phone:502-222-5005
Mailing Address - Fax:800-491-8171
Practice Address - Street 1:0224 SW HAMILTON ST STE 101
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-6418
Practice Address - Country:US
Practice Address - Phone:502-222-5005
Practice Address - Fax:800-491-8171
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2017-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00250171100000X
OR2317111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR051297OtherCONTRACTOR
OR051297OtherCONTRACTOR
ORR0000QGFRWMedicare PIN