Provider Demographics
NPI:1225190697
Name:PLUMMER, KEVIN JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:JOHN
Last Name:PLUMMER
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 1:1742 W 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-3710
Mailing Address - Country:US
Mailing Address - Phone:154-134-3844
Mailing Address - Fax:541-343-8449
Practice Address - Street 1:1742 W 10TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-3710
Practice Address - Country:US
Practice Address - Phone:541-343-8449
Practice Address - Fax:541-343-0350
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3433111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor