Individual
JACK PORTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1634 HELENA DR, MANSFIELD, OH 44904-1817
(419) 543-6853
Mailing address
1634 HELENA DR, MANSFIELD, OH 44904-1817
(419) 543-6853
Taxonomy
Speciality
Code
Description
License number
State
347C00000X
Private Vehicle
Primary
UT015692
OH
376J00000X
Homemaker
—
—
Other
Enumeration date
09/19/2023
Last updated
09/19/2023
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