Provider Demographics
NPI:1497050116
Name:TALBERT, JENNIFER LOUISE (DC)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LOUISE
Last Name:TALBERT
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 1:2031 E BURNSIDE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-1649
Mailing Address - Country:US
Mailing Address - Phone:503-224-2100
Mailing Address - Fax:503-224-2129
Practice Address - Street 1:2031 E BURNSIDE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-1649
Practice Address - Country:US
Practice Address - Phone:503-224-2100
Practice Address - Fax:503-224-2129
Is Sole Proprietor?:No
Enumeration Date:2011-01-12
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011001121111N00000X
MECR2148111N00000X
OR5919111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor