Provider Demographics
NPI:1841888658
Name:EDDINS, JO
Entity type:Individual
Prefix:
First Name:JO
Middle Name:
Last Name:EDDINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12501 NE STANTON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-1651
Mailing Address - Country:US
Mailing Address - Phone:503-740-5265
Mailing Address - Fax:
Practice Address - Street 1:354 ULUNIU ST STE 100
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2532
Practice Address - Country:US
Practice Address - Phone:808-261-4040
Practice Address - Fax:808-744-2077
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-07
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6124111N00000X
HI1531111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor