Provider Demographics
NPI:1386866424
Name:LEWIS, JAYLENE (DC)
Entity Type:Individual
Prefix:DR
First Name:JAYLENE
Middle Name:
Last Name:LEWIS
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 1:1895 NW 188TH AVE
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97006-6485
Mailing Address - Country:US
Mailing Address - Phone:503-718-7161
Mailing Address - Fax:503-268-1691
Practice Address - Street 1:1895 NW 188TH AVE
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97006-6485
Practice Address - Country:US
Practice Address - Phone:503-718-7161
Practice Address - Fax:503-268-1691
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3354111N00000X
OR14086225700000X
CA23298111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist