Provider Demographics
NPI:1730161480
Name:SNEEUWJAGT, JENNIFER ANN (DC)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ANN
Last Name:SNEEUWJAGT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:ANN
Other - Last Name:PANKONIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 973
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:OR
Mailing Address - Zip Code:97338-0973
Mailing Address - Country:US
Mailing Address - Phone:503-831-4820
Mailing Address - Fax:
Practice Address - Street 1:306 MAIN ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:OR
Practice Address - Zip Code:97338-3305
Practice Address - Country:US
Practice Address - Phone:503-831-4820
Practice Address - Fax:888-636-9475
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2019-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5591111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC028173Medicare ID - Type Unspecified