Provider Demographics
NPI:1962419622
Name:ROBINSON, JEFF M (DC)
Entity type:Individual
Prefix:
First Name:JEFF
Middle Name:M
Last Name:ROBINSON
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 1:4000 KRUSE WAY PLACE
Mailing Address - Street 2:3-#245
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035
Mailing Address - Country:US
Mailing Address - Phone:503-593-7640
Mailing Address - Fax:503-305-8849
Practice Address - Street 1:4000 KRUSE WAY PLACE
Practice Address - Street 2:3-#245
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035
Practice Address - Country:US
Practice Address - Phone:503-593-7640
Practice Address - Fax:503-305-8849
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3262111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor