Provider Demographics
NPI:1699075713
Name:BARTRAM, JEANNIE KOLLEEN (LMT)
Entity type:Individual
Prefix:MS
First Name:JEANNIE
Middle Name:KOLLEEN
Last Name:BARTRAM
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 W 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-5115
Mailing Address - Country:US
Mailing Address - Phone:541-343-1942
Mailing Address - Fax:541-484-1946
Practice Address - Street 1:709 W 7TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-5115
Practice Address - Country:US
Practice Address - Phone:541-343-1942
Practice Address - Fax:541-484-1946
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-22
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12248111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor