Provider Demographics
NPI:1518755248
Name:MCCOY, JENNIFER ROSE (LAC, DACM)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ROSE
Last Name:MCCOY
Suffix:
Gender:F
Credentials:LAC, DACM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 N BALDWIN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-1421
Mailing Address - Country:US
Mailing Address - Phone:541-552-0270
Mailing Address - Fax:
Practice Address - Street 1:316 N BALDWIN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-1421
Practice Address - Country:US
Practice Address - Phone:541-552-0270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC223684171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist