Provider Demographics
NPI:1518340439
Name:JEWELL, LISA (DC)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:JEWELL
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 1:2425 SE PINE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-1735
Mailing Address - Country:US
Mailing Address - Phone:920-216-2958
Mailing Address - Fax:
Practice Address - Street 1:319 SW WASHINGTON ST STE 1001
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97204-2615
Practice Address - Country:US
Practice Address - Phone:503-224-5010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-09
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5655111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor