Individual
JERROD PUCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
6230 NE HALSEY ST, PORTLAND, OR 97213-4718
(971) 279-2294
Mailing address
6230 NE HALSEY ST, PORTLAND, OR 97213-4718
(971) 279-2294
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
5895
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500740636
—
OR
Enumeration date
02/27/2018
Last updated
03/05/2020
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