Provider Demographics
NPI:1508236886
Name:GARRISON, JESSICA MAE (DC)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:MAE
Last Name:GARRISON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:MAE
Other - Last Name:GARRISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:114 E HANCOCK ST
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-2822
Mailing Address - Country:US
Mailing Address - Phone:503-554-0661
Mailing Address - Fax:
Practice Address - Street 1:10150 NW GLENCOE RD
Practice Address - Street 2:
Practice Address - City:NORTH PLAINS
Practice Address - State:OR
Practice Address - Zip Code:97133-8226
Practice Address - Country:US
Practice Address - Phone:503-336-3335
Practice Address - Fax:503-336-3648
Is Sole Proprietor?:No
Enumeration Date:2015-09-30
Last Update Date:2017-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5673111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor