Provider Demographics
NPI:1528381332
Name:DR. KIM JAMESON, DC, LLC
Entity Type:Organization
Organization Name:DR. KIM JAMESON, DC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIM
Authorized Official - Middle Name:A
Authorized Official - Last Name:JAMESON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-454-0782
Mailing Address - Street 1:11804 SE SUNNYSIDE RD
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-9308
Mailing Address - Country:US
Mailing Address - Phone:503-454-0782
Mailing Address - Fax:
Practice Address - Street 1:11804 SE SUNNYSIDE RD
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-9308
Practice Address - Country:US
Practice Address - Phone:503-454-0782
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-08
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR71-3888111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty