Provider Demographics
NPI:1841689551
Name:KATZ, JEREMY MATTHEW RYAN (DC)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:MATTHEW RYAN
Last Name:KATZ
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 1:2525 NW LOVEJOY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-2859
Mailing Address - Country:US
Mailing Address - Phone:503-972-3333
Mailing Address - Fax:503-548-2850
Practice Address - Street 1:2525 NW LOVEJOY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2859
Practice Address - Country:US
Practice Address - Phone:503-972-3333
Practice Address - Fax:503-548-2850
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-19
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5611111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor