Provider Demographics
NPI:1174589279
Name:MEANS, JENNIFER DALE (ND, LAC)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:DALE
Last Name:MEANS
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4970 SW MAIN AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005
Mailing Address - Country:US
Mailing Address - Phone:503-641-6400
Mailing Address - Fax:503-641-6401
Practice Address - Street 1:4970 SW MAIN AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005
Practice Address - Country:US
Practice Address - Phone:503-641-6400
Practice Address - Fax:503-641-6401
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORACU0300171100000X
OR857175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR226292Medicaid