Provider Demographics
NPI:1629372354
Name:SHI, JIAN (DC)
Entity Type:Individual
Prefix:MS
First Name:JIAN
Middle Name:
Last Name:SHI
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 1:10626 NE GLISAN STREET
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-4045
Mailing Address - Country:US
Mailing Address - Phone:503-896-0660
Mailing Address - Fax:
Practice Address - Street 1:10626 NE GLISAN STREET
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-4045
Practice Address - Country:US
Practice Address - Phone:503-896-0660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-10
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4074111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor