Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 1818 | OR |
N | 111NI0013X | Independent Medical Examiner | 1818 | OR |
NPI | 1801047733 |
---|---|
Provider Name | Dr. Jeffery S Hawkins |
First Address | Tualatin, OR 97062-1993 |
Second Address | Tigard, OR 97223-6005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2008 |
Last Update Date | 09/10/2008 |