Jack E Pedersen, D. C.
Individual provider Active NPI Chiropractor · Sweet Home, OR
NPI 1609959568 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1609959568
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 1401 (OR)
- Practice address
- 1235 Main St
Sweet Home, OR 97386-1609 - Phone
- (541) 367-2105
- NPI assigned
- Oct 23, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1401 | OR | MD | Chiropractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 1401 | OR | Yes |
Addresses
Primary practice location
1235 Main St
Sweet Home, OR 97386-1609
Mailing address
1235 Main St
Sweet Home, OR 97386-1609
Phone (541) 367-2105
Other providers in Sweet Home, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.