Provider Demographics
NPI:1790929321
Name:JADERHOLM, CHRISTINA MANDRUP (DC)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:MANDRUP
Last Name:JADERHOLM
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:MANDRUP
Other - Last Name:ANDERSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:2031 E BURNSIDE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-1649
Mailing Address - Country:US
Mailing Address - Phone:503-224-2100
Mailing Address - Fax:
Practice Address - Street 1:2031 E BURNSIDE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-1649
Practice Address - Country:US
Practice Address - Phone:503-224-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-27
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60074921111N00000X
OR4108111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor