Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 020612765 | OR |
NPI | 1225589682 |
---|---|
Provider Name | Kristy Stein |
First Address | Molalla, OR 97038-8500 |
Second Address | Portland, OR 97222-6001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2016 |
Last Update Date | 20/10/2016 |