Provider Demographics
NPI:1679763734
Name:JAMESON, KIM (DC)
Entity type:Individual
Prefix:DR
First Name:KIM
Middle Name:
Last Name:JAMESON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 NW MILLER ST
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-7226
Mailing Address - Country:US
Mailing Address - Phone:503-665-2344
Mailing Address - Fax:503-701-3113
Practice Address - Street 1:130 NW MILLER ST
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-7226
Practice Address - Country:US
Practice Address - Phone:503-665-2344
Practice Address - Fax:503-701-3113
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-25
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24425111N00000X
OR71-3888111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor