Provider Demographics
NPI:1134439409
Name:WILLIAMS, JEFFREY MITCHELL (DC)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:MITCHELL
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15962 BOONES FERRY RD STE 202
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-4360
Mailing Address - Country:US
Mailing Address - Phone:503-305-6585
Mailing Address - Fax:503-344-6033
Practice Address - Street 1:460 N VILLA RD
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-1800
Practice Address - Country:US
Practice Address - Phone:503-305-6585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-20
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4054111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor