Healthcare Provider Details

I. General information

NPI: 1124628417
Provider Name (Legal Business Name): BIOHAX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2020
Last Update Date: 12/15/2020
Certification Date: 12/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17933 NW EVERGREEN PKWY STE 285
BEAVERTON OR
97006-7661
US

IV. Provider business mailing address

17933 NW EVERGREEN PKWY STE 285
BEAVERTON OR
97006-7661
US

V. Phone/Fax

Practice location:
  • Phone: 503-828-9265
  • Fax: 503-303-8997
Mailing address:
  • Phone: 503-828-9265
  • Fax: 503-303-8997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER KLERONOMOS
Title or Position: OWNER
Credential: FNP, DAOM, MSC
Phone: 503-828-9265