Provider Demographics
NPI:1790005106
Name:YCASAS, TERRY JAY (DC)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:JAY
Last Name:YCASAS
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 1:1515 NE 26TH AVE
Mailing Address - Street 2:#5
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1795
Mailing Address - Country:US
Mailing Address - Phone:503-866-4680
Mailing Address - Fax:
Practice Address - Street 1:1515 NE 26TH AVE
Practice Address - Street 2:#5
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1795
Practice Address - Country:US
Practice Address - Phone:503-866-4680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-08
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4021111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor