Individual
JAEDON CHURCHILL DICKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
7318 N LEAVITT AVE, PORTLAND, OR 97203-4840
(503) 567-5880
Mailing address
8222 N EDISON ST, PORTLAND, OR 97203-4912
(541) 728-6867
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
28873
OR
Other
Enumeration date
04/11/2025
Last updated
04/22/2025
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