Individual
JESSICA SOUTHAVILAY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DC, LMT
Contact information
Practice address
818 SE CESAR E CHAVEZ BLVD, PORTLAND, OR 97214-4357
(503) 473-4680
Mailing address
818 SE CESAR E CHAVEZ BLVD, PORTLAND, OR 97214-4357
(503) 897-0818
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
5848
OR
225700000X
Massage Therapist
OR12773
OR
Other
Enumeration date
01/27/2015
Last updated
03/06/2018
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