Individual
JEROME GAVIN CRAIG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC, LMT
Contact information
Practice address
118 N KILLINGSWORTH ST, PORTLAND, OR 97217-2435
(503) 288-4454
(503) 288-1783
Mailing address
118 N KILLINGSWORTH ST, PORTLAND, OR 97217-2435
(503) 288-4454
(503) 288-1783
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
3896
OR
171W00000X
Contractor
11637
OR
Other
Enumeration date
11/17/2008
Last updated
01/22/2009
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