Healthcare Provider Details

I. General information

NPI: 1639462484
Provider Name (Legal Business Name): MR. STEVEN DANIEL HOHENBOKEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2011
Last Update Date: 09/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2143 NE BROADWAY ST #2
PORTLAND OR
97232-1512
US

IV. Provider business mailing address

2143 NE BROADWAY ST #2
PORTLAND OR
97232-1512
US

V. Phone/Fax

Practice location:
  • Phone: 503-753-6619
  • Fax:
Mailing address:
  • Phone: 503-753-6619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: