Provider Demographics
NPI:1972611564
Name:CUMMINGS, JEANETTE MARIE (DC)
Entity type:Individual
Prefix:DR
First Name:JEANETTE
Middle Name:MARIE
Last Name:CUMMINGS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4531 SE BELMONT ST STE 203
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-1675
Mailing Address - Country:US
Mailing Address - Phone:503-236-9609
Mailing Address - Fax:503-236-2906
Practice Address - Street 1:4531 SE BELMONT ST STE 203
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-1675
Practice Address - Country:US
Practice Address - Phone:503-236-9609
Practice Address - Fax:503-236-2906
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2811111N00000X
OR272811111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORU42207Medicare UPIN
OR0000QGFWXMedicare ID - Type UnspecifiedCHIROPRACTOR