Jessica Southavilay Jackson, DC, LMT

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

5848 Issued in OR

Practice address

818 SE Cesar E Chavez Blvd
Portland, OR 97214-4357

Phone

(503) 473-4680

NPI assigned

Jan 27, 2015

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Suneya Wellness LLC

  • Chiropractor
  • Portland, OR
  • NPI 1669827457
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1422316800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1520294400000",
    "number": "1053701201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "818 SE CESAR E CHAVEZ BLVD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972144357",
            "telephone_number": "503-897-0818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "818 SE CESAR E CHAVEZ BLVD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972144357",
            "telephone_number": "503-473-4680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOUTHAVILAY JACKSON",
        "first_name": "JESSICA",
        "credential": "DC, LMT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-01-27",
        "last_updated": "2018-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "OR",
            "license": "OR12773",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "OR",
            "license": "5848",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sourcing Vitality, Inc.
• South Tabor Family Physicians
• South Waterfront Eye Care Inc.
• Joyce Southall, RN
• Rebecca Southard
• Southeast Dental PC
• Southeast Dental Professionals
• Southeast Physical Therapy, P.C.
• Cassandra Southerland, BSW
• Southern Home Care Services, Inc.

• Chiropractor in Portland, OR
• Providers in Portland, OR by specialty
• Chiropractor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.