Healthcare Provider Details

I. General information

NPI: 1164853677
Provider Name (Legal Business Name): FIBROMYALGIA AND NEUROMUSCULAR PAIN CENTER OF OREGON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2013
Last Update Date: 05/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 BELLEVUE ST SE SUITE 225
SALEM OR
97301-3819
US

IV. Provider business mailing address

700 BELLEVUE ST SE SUITE 225
SALEM OR
97301-3819
US

V. Phone/Fax

Practice location:
  • Phone: 844-724-6789
  • Fax: 844-724-6789
Mailing address:
  • Phone: 844-724-6789
  • Fax: 844-724-6789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: CHRIS ADAM KLERONOMOS
Title or Position: OWNER
Credential: DAOM, FNP
Phone: 425-318-0300