Provider Demographics
NPI:1275085680
Name:MCNALLY, JEFFREY ERIC (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ERIC
Last Name:MCNALLY
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 1:2835 SE 25TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-1220
Mailing Address - Country:US
Mailing Address - Phone:267-733-8560
Mailing Address - Fax:
Practice Address - Street 1:4035 MERCANTILE DR
Practice Address - Street 2:#112
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-2546
Practice Address - Country:US
Practice Address - Phone:503-850-4526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-02
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5767111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor