Provider Demographics
NPI:1518234350
Name:JELEN, JUSTIN RYAN (DC)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:RYAN
Last Name:JELEN
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 1:15962 BOONES FERRY RD STE 202
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-4360
Mailing Address - Country:US
Mailing Address - Phone:503-305-6585
Mailing Address - Fax:503-344-6033
Practice Address - Street 1:15962 BOONES FERRY RD STE 202
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-4360
Practice Address - Country:US
Practice Address - Phone:503-305-6585
Practice Address - Fax:503-344-6033
Is Sole Proprietor?:No
Enumeration Date:2011-11-22
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5018111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician