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General NPI Number Information
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NPI Number | 1477092005
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Entity Type | Organization
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Legal Business Name | EN8 INC.
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Dates
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Enumeration Date | 02/15/2017
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Last Update Date | 02/15/2017
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Provider Practice Location Address
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Address Line | 1707 LANSING AVE NE
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City | SALEM
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State | OR
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Zip | 97301-8732
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Country | US
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Telephone | 503-364-9242
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Fax | 503-371-5325
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Provider Business Mailing Address
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Address Line | 1707 LANSING AVE NE
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City | SALEM
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State | OR
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Zip | 97301-8732
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Country | US
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Telephone | 503-364-9242
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Fax | 503-371-5325
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL JON CLINE
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Credential | LMT
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Telephone | 503-364-9242
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 7586
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License Number State | OR
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