Provider Demographics
NPI:1043792856
Name:ARCHAMBAULT, JENNIE-MARIE EVANKA (DC)
Entity type:Individual
Prefix:DR
First Name:JENNIE-MARIE
Middle Name:EVANKA
Last Name:ARCHAMBAULT
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 1:3990 COLLINS WAY
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-3480
Mailing Address - Country:US
Mailing Address - Phone:503-805-9680
Mailing Address - Fax:
Practice Address - Street 1:3990 COLLINS WAY
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035
Practice Address - Country:US
Practice Address - Phone:503-635-1236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-29
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5923111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor