Provider Demographics
NPI:1629101209
Name:ZIEMER, LAURA JO (DC)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:JO
Last Name:ZIEMER
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 1:7112 SW CANYON LN
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-3726
Mailing Address - Country:US
Mailing Address - Phone:503-297-9097
Mailing Address - Fax:
Practice Address - Street 1:7420 SW GARDEN HOME RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-9569
Practice Address - Country:US
Practice Address - Phone:503-245-7711
Practice Address - Fax:503-245-7712
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2258111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR0000QGDHLMedicare ID - Type Unspecified