Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 023266 | OR |
NPI | 1073040945 |
---|---|
Provider Name | Taylor Justine Mohr |
First Address | Portland, OR 97220-3749 |
Second Address | Portland, OR 97230-2350 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2017 |
Last Update Date | 22/05/2017 |