Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | OR |
NPI | 1689632390 |
---|---|
Provider Name | Dr. Jerry Eugene Hearns |
First Address | Medford, OR 97504-7027 |
Second Address | Medford, OR 97504-7027 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2006 |
Last Update Date | 08/07/2007 |