Provider Demographics
NPI:1023098050
Name:JARVIE, NOAH G (DC)
Entity type:Individual
Prefix:DR
First Name:NOAH
Middle Name:G
Last Name:JARVIE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 W MAIN ST
Mailing Address - Street 2:UNIT 2
Mailing Address - City:ROGUE RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97537-9611
Mailing Address - Country:US
Mailing Address - Phone:541-582-6508
Mailing Address - Fax:
Practice Address - Street 1:109 W MAIN ST UNIT 2
Practice Address - Street 2:
Practice Address - City:ROGUE RIVER
Practice Address - State:OR
Practice Address - Zip Code:97537-9611
Practice Address - Country:US
Practice Address - Phone:541-582-6508
Practice Address - Fax:541-582-6530
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27-3173111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORU80017Medicare UPIN