NPIMap

Individual provider Active NPI

Jesse Layne Nuttall, D.C.

  • Chiropractor
  • Gresham, OR
National Provider Identifier
1255404612
Registry record updated Jul 22, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
273624 Issued in OR
Practice address
333 SE 223Rd Ave Ste 206
Gresham, OR 97030-7454
Phone
(503) 489-2992
NPI assigned
Nov 15, 2006
Last updated
Jul 22, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 273624 OR Primary

Addresses

Primary practice location

333 SE 223Rd Ave Ste 206
Gresham, OR 97030-7454

Mailing address

333 SE 223Rd Ave Ste 206
Gresham, OR 97030-7454
Phone (503) 489-2992

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
273624ORMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Drop-in Chiropractic Inc. Chiropractor Past Accepting new patients

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1374451200000",
    "number": "1255404612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 SE 223RD AVE STE 206",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970307454",
            "telephone_number": "503-489-2992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 SE 223RD AVE STE 206",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970307454",
            "telephone_number": "503-489-2992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NUTTALL",
        "first_name": "JESSE",
        "middle_name": "LAYNE",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-15",
        "last_updated": "2013-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "OR",
            "license": "273624",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gresham, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2013; 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.