Provider Demographics
NPI:1275554149
Name:PORTMANN, JEREMY R (DC)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:R
Last Name:PORTMANN
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 1:204 W HIGH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW PHILADELPHIA
Mailing Address - State:OH
Mailing Address - Zip Code:44663-3812
Mailing Address - Country:US
Mailing Address - Phone:330-440-6700
Mailing Address - Fax:330-440-6701
Practice Address - Street 1:204 W HIGH AVE
Practice Address - Street 2:
Practice Address - City:NEW PHILADELPHIA
Practice Address - State:OH
Practice Address - Zip Code:44663-3812
Practice Address - Country:US
Practice Address - Phone:330-440-6700
Practice Address - Fax:330-440-6701
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11297111N00000X
OH3732111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor