Provider Demographics
NPI:1225376932
Name:SONTAG, JEREMY ELIAS (DC)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:ELIAS
Last Name:SONTAG
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 1:305 W 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2510
Mailing Address - Country:US
Mailing Address - Phone:541-550-7052
Mailing Address - Fax:
Practice Address - Street 1:305 W 7TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401
Practice Address - Country:US
Practice Address - Phone:541-550-7052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-30
Last Update Date:2018-06-06
Deactivation Date:2018-03-22
Deactivation Code:
Reactivation Date:2018-06-05
Provider Licenses
StateLicense IDTaxonomies
OR5872111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR197692Medicaid