Provider Demographics
NPI:1649452277
Name:BELL, JACOB M (DC)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:M
Last Name:BELL
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 1:2223 NE 51ST AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-2507
Mailing Address - Country:US
Mailing Address - Phone:503-724-8351
Mailing Address - Fax:
Practice Address - Street 1:530000 BREITENBUSH RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:OR
Practice Address - Zip Code:97342
Practice Address - Country:US
Practice Address - Phone:503-724-8351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-05
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3755111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR143237Medicare UPIN