Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 5893 | OR |
N | 225700000X | Massage Therapist | 18150 | OR |
NPI | 1013257682 |
---|---|
Provider Name | Dr. Kelley Marie Henry |
First Address | Portland, OR 97210-2648 |
Second Address | Portland, OR 97210-2224 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2013 |
Last Update Date | 24/02/2018 |