Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 5897 | OR |
N | 226300000X | Kinesiotherapist |
NPI | 1770910242 |
---|---|
Provider Name | Dr. Jennifer Nicole Martin |
First Address | Silverton, OR 97381-1265 |
Second Address | Woodburn, OR 97071-3674 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2013 |
Last Update Date | 26/06/2018 |