Provider Demographics
NPI:1851643142
Name:DR. BARBARA JOLLEY, DC, DC, PC
Entity Type:Organization
Organization Name:DR. BARBARA JOLLEY, DC, DC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOLLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC, ND
Authorized Official - Phone:503-245-9949
Mailing Address - Street 1:3644 SW TROY ST
Mailing Address - Street 2:#200
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-1684
Mailing Address - Country:US
Mailing Address - Phone:503-245-9949
Mailing Address - Fax:503-977-0502
Practice Address - Street 1:3644 SW TROY ST
Practice Address - Street 2:#200
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-1684
Practice Address - Country:US
Practice Address - Phone:503-245-9949
Practice Address - Fax:503-977-0502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-10
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2083111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty