Provider Demographics
NPI:1023983301
Name:TRAN, JIMMY (DC)
Entity type:Individual
Prefix:
First Name:JIMMY
Middle Name:
Last Name:TRAN
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 1:10384 SE 96TH AVE
Mailing Address - Street 2:
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086-7207
Mailing Address - Country:US
Mailing Address - Phone:503-484-7452
Mailing Address - Fax:
Practice Address - Street 1:10415 SE STARK ST STE F
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2764
Practice Address - Country:US
Practice Address - Phone:503-206-5747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-07
Last Update Date:2025-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6468111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor