Provider Demographics
NPI:1578092573
Name:MARTENS, JENNIFER RENAE (DC, LMT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:RENAE
Last Name:MARTENS
Suffix:
Gender:F
Credentials:DC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1837 PACIFIC AVE APT 112
Mailing Address - Street 2:
Mailing Address - City:FOREST GROCE
Mailing Address - State:OR
Mailing Address - Zip Code:97116
Mailing Address - Country:US
Mailing Address - Phone:503-359-9557
Mailing Address - Fax:503-214-8622
Practice Address - Street 1:1837 PACIFIC AVE APT 112
Practice Address - Street 2:
Practice Address - City:FOREST GROCE
Practice Address - State:OR
Practice Address - Zip Code:97116
Practice Address - Country:US
Practice Address - Phone:503-359-9557
Practice Address - Fax:503-214-8622
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-05
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6420111N00000X, 111NN0400X, 111NR0400X, 225700000X
OR023248225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Multi-Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty