Provider Demographics
NPI:1235188731
Name:REDDIN, JASMAR (DC)
Entity Type:Individual
Prefix:DR
First Name:JASMAR
Middle Name:
Last Name:REDDIN
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 1:11731 NE GLISAN
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-2141
Mailing Address - Country:US
Mailing Address - Phone:503-238-1601
Mailing Address - Fax:503-238-1078
Practice Address - Street 1:11731 NE GLISAN
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-2141
Practice Address - Country:US
Practice Address - Phone:503-238-1601
Practice Address - Fax:503-238-1078
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR272239111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1427234509OtherGROUP NPI
350055506OtherRAILROAD MEDICARE
350055506OtherRAILROAD MEDICARE
OR112317Medicare ID - Type UnspecifiedGR