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General NPI Number Information
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NPI Number | 1013257682
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Entity Type | Individual
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Provider Name | KELLEY MARIE HENRY DC, PHD, LMT, HFS
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Gender | Female
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Dates
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Enumeration Date | 02/19/2013
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Last Update Date | 02/24/2018
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Provider Practice Location Address
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Address Line | 2600 NW VAUGHN ST
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City | PORTLAND
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State | OR
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Zip | 97210-2224
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Country | US
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Telephone | 508-864-1056
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Fax |
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Provider Business Mailing Address
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Address Line | 2465 NW RALEIGH ST APT. 107
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City | PORTLAND
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State | OR
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Zip | 97210-2648
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Country | US
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Telephone | 508-864-1056
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 18150
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 5893
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License Number State | OR
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