Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 27-1737 | OR |
NPI | 1043302409 |
---|---|
Provider Name | Dr. Ronald R Johansen |
First Address | Portland, OR 97233-1539 |
Second Address | Portland, OR 97233-1539 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2006 |
Last Update Date | 08/07/2007 |