Provider Demographics
NPI:1750136008
Name:LOVE, JENNIFER M (DC)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:M
Last Name:LOVE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4335 NE SUMNER ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97218-1543
Mailing Address - Country:US
Mailing Address - Phone:503-309-3350
Mailing Address - Fax:
Practice Address - Street 1:3810 SE DIVISION ST STE C
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-1678
Practice Address - Country:US
Practice Address - Phone:971-645-7576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-20
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6374111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor