Healthcare Provider Details

I. General information

NPI: 1144540436
Provider Name (Legal Business Name): CHRISTOPHER ADAM KLERONOMOS FNP, DAOM, MSC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2010
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 NW JOHNSON ST
PORTLAND OR
97209-3011
US

IV. Provider business mailing address

1210 NW JOHNSON ST
PORTLAND OR
97209-3011
US

V. Phone/Fax

Practice location:
  • Phone: 971-299-8350
  • Fax:
Mailing address:
  • Phone: 971-299-8350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201050042NP
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC150573
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code2083S0010X
TaxonomySports Medicine (Preventive Medicine) Physician
License Number201050042NP
License Number StateOR
# 5
Primary TaxonomyN
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number201050042NP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: