Individual
DR. JORDAN GUY PROBASCO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
12661 SE POWELL BLVD, SUITE B, PORTLAND, OR 97236-3400
(503) 801-8888
Mailing address
1039 SE 78TH AVE, PORTLAND, OR 97215-3006
(509) 435-7124
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
5631
OR
111NP0017X
Pediatric Chiropractor
5631
OR
111NR0400X
Rehabilitation Chiropractor
5631
OR
111NX0100X
Occupational Health Chiropractor
5631
OR
111NX0800X
Orthopedic Chiropractor
5631
OR
Other
Enumeration date
05/07/2015
Last updated
05/07/2015
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