Provider Demographics
NPI:1154302735
Name:PITCAIRN, JENNIFER (DC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:PITCAIRN
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 1:365 WARNER MILNE RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-4073
Mailing Address - Country:US
Mailing Address - Phone:503-557-9266
Mailing Address - Fax:503-557-9220
Practice Address - Street 1:365 WARNER MILNE RD
Practice Address - Street 2:SUITE 105
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-4073
Practice Address - Country:US
Practice Address - Phone:503-557-9266
Practice Address - Fax:503-557-9220
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27-2995111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR112191Medicare PIN