Provider Demographics
NPI:1437930963
Name:CRUZ, JONATHAN KEVIN (DC)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:KEVIN
Last Name:CRUZ
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 1:1905 MAIN ST APT 302
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-1074
Mailing Address - Country:US
Mailing Address - Phone:541-232-6479
Mailing Address - Fax:
Practice Address - Street 1:4847 MEADOWS RD STE 153
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-2626
Practice Address - Country:US
Practice Address - Phone:971-330-8578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-10
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6335111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor