Provider Demographics
NPI:1245399658
Name:BRATTEN, JEFFREY (DC, BS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:BRATTEN
Suffix:
Gender:M
Credentials:DC, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 NE HOGAN DR
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-4129
Mailing Address - Country:US
Mailing Address - Phone:503-667-3366
Mailing Address - Fax:503-465-8486
Practice Address - Street 1:1155 NE HOGAN DR
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-4129
Practice Address - Country:US
Practice Address - Phone:503-667-3366
Practice Address - Fax:503-465-8486
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR272765111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR93-1083040OtherTAX ID #
OR93-1083040OtherTAX ID #