MEDICARE: JKA ENTERPRISES,INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	6704	OR

General Provider Information

NPI Number	:	1851627483
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JKA ENTERPRISES,INC

Provider Business Mailing Address
First Line	:	21285 SE IDLEWINE RD
Second Line	:
City	:	EAGLE CREEK
State	:	OR
Zip	:	97022-9755
Country	:	US
Telephone Number	:	503-860-4819
Fax Number	:

Provider Business Practice Location Address
First Line	:	15800 BOONES FERRY RD STE B1
Second Line	:
City	:	LAKE OSWEGO
State	:	OR
Zip	:	97035-3456
Country	:	US
Telephone Number	:	503-860-4819
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KATHERINE A ADAMS
Credential	:	LMT
Telephone Number	:	503-860-4819

Provider Enumeration Date	:	11/02/2009
Last Update Date	:	11/02/2009

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