Provider Demographics
NPI:1487771622
Name:ELLIS, JAMIE MARIE (DC)
Entity type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:MARIE
Last Name:ELLIS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33608 E COLUMBIA AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:SCAPPOOSE
Mailing Address - State:OR
Mailing Address - Zip Code:97056-3442
Mailing Address - Country:US
Mailing Address - Phone:503-987-4100
Mailing Address - Fax:503-987-4107
Practice Address - Street 1:33608 E COLUMBIA AVE STE 110
Practice Address - Street 2:
Practice Address - City:SCAPPOOSE
Practice Address - State:OR
Practice Address - Zip Code:97056-3442
Practice Address - Country:US
Practice Address - Phone:503-987-4100
Practice Address - Fax:503-987-4107
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2023-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4103111N00000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor