Individual provider Active NPI

Jennifer Ann Fletcher, D.C., LAC.

  • Chiropractor
  • Portland, OR
National Provider Identifier
1487608147
Registry record updated Jul 31, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
2317 Issued in OR
Practice address
0224 SW Hamilton St Ste 101
Portland, OR 97239-6418
Phone
(502) 222-5005
Fax
(800) 491-8171
NPI assigned
May 19, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 31, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Acupuncturist 171100000X AC00250 OR
Chiropractor 111N00000X 2317 OR Primary

Addresses

Primary practice location

0224 SW Hamilton St Ste 101
Portland, OR 97239-6418

Mailing address

0224 SW Hamilton St Ste 101
Portland, OR 97239-6418
Phone (502) 222-5005

Other identifiers 1

IdentifierTypeStateIssuer
051297OtherORCONTRACTOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210527000545 OR Practitioner - Chiropractic 0941609705 Practice locations: Portland, OR

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
AC00250ORMDAcupuncturist

NPI Registry JSON

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

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1501459200000",
    "number": "1487608147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "0224 SW HAMILTON ST STE 101",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972396418",
            "telephone_number": "502-222-5005",
            "fax_number": "800-491-8171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "0224 SW HAMILTON ST STE 101",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972396418",
            "telephone_number": "502-222-5005",
            "fax_number": "800-491-8171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FLETCHER",
        "first_name": "JENNIFER",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "D.C., LAC.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-05-19",
        "last_updated": "2017-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "OR",
            "license": "AC00250",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "OR",
            "license": "2317",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CONTRACTOR",
            "identifier": "051297",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.