Provider Demographics
NPI:1902005770
Name:CHLEBOWSKI, J CHRIS (DC, ND)
Entity Type:Individual
Prefix:DR
First Name:J
Middle Name:CHRIS
Last Name:CHLEBOWSKI
Suffix:
Gender:M
Credentials:DC, ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2107 SE 43RD AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-3709
Mailing Address - Country:US
Mailing Address - Phone:503-750-1724
Mailing Address - Fax:
Practice Address - Street 1:2107 SE 43RD AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-3709
Practice Address - Country:US
Practice Address - Phone:503-750-1724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3744111N00000X
OR1886175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No175F00000XOther Service ProvidersNaturopath