Provider Demographics
NPI:1437458619
Name:TERRELL, JEAN ANN (LMT)
Entity Type:Individual
Prefix:MS
First Name:JEAN
Middle Name:ANN
Last Name:TERRELL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11125 NE SANDY BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-2555
Mailing Address - Country:US
Mailing Address - Phone:503-257-3377
Mailing Address - Fax:503-257-3432
Practice Address - Street 1:11125 NE SANDY BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-2555
Practice Address - Country:US
Practice Address - Phone:503-257-3377
Practice Address - Fax:503-257-3432
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-27
Last Update Date:2011-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5626111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor