Jerrod Puckett, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

5895 Issued in OR

Practice address

6230 NE Halsey St
Portland, OR 97213-4718

Phone

(971) 279-2294

NPI assigned

Feb 27, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

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.

• Inner Gate Acupuncture LLC

  • Acupuncturist
  • Portland, OR
  • NPI 1306019310

  Chiropractor

  NPD

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

{
    "created_epoch": "1519689600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583366400000",
    "number": "1356842066",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6230 NE HALSEY ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972134718",
            "telephone_number": "971-279-2294"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6230 NE HALSEY ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972134718",
            "telephone_number": "971-279-2294"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "862 SE Oak St Ste 2A",
            "address_purpose": "LOCATION",
            "city": "Hillsboro",
            "state": "OR",
            "postal_code": "971234240",
            "country_code": "US",
            "telephone_number": "503-648-6997",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PUCKETT",
        "first_name": "JERROD",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-02-27",
        "last_updated": "2020-03-05",
        "certification_date": "2020-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "OR",
            "license": "5895",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500740636",
            "state": "OR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jerrod@innergateacupuncture.com",
            "affiliation": "N",
            "endpointDescription": "Email Address - Work",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "6230 NE Halsey St",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972134718",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• PT & OT of Oregon, LLC
• Ashley Marie Ptaszynski
• Ptmobile Physical Therapy LLC
• Patrick C. Pua, P.T.
• Sherly Pual
• Robert Puckett, MFT
• Gopal Pudasaini, MEDICAL STUDENT
• Ritika Pudota, DO
• Katherine H Pugh, N.D.
• Tia Pugh

• 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 5, 2020; 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.