Provider Demographics
NPI:1861537003
Name:PREISS, JONATHAN STEWART (DC)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:STEWART
Last Name:PREISS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7412 SW BEAVERTON HILLSDALE HWY
Mailing Address - Street 2:SUITE 109
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-2162
Mailing Address - Country:US
Mailing Address - Phone:503-291-1212
Mailing Address - Fax:503-291-1772
Practice Address - Street 1:7412 SW BEAVERTON HILLSDALE HWY
Practice Address - Street 2:SUITE 109
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-2162
Practice Address - Country:US
Practice Address - Phone:503-291-1212
Practice Address - Fax:503-291-1772
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27 2711111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORT42043Medicare UPIN
ORR0000QGFZPMedicare ID - Type Unspecified