# GREY FOREST WELLNESS LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053761544
- **Authorized official:** ANDREA LYNN OTKEN DC (PRESIDENT)
- **Authorized official phone:** (727) 265-0804

## Contact information

- **Practice address:** 795 PIEDMONT AVE NW, SALEM, OR 97304-4308
- **Practice address phone:** (727) 265-0804
- **Mailing address:** 795 PIEDMONT AVE NW, SALEM, OR 97304-4308
- **Mailing address phone:** (727) 265-0804

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111NN1001X | Nutrition Chiropractor | 5644 | OR | Yes |

## Other

- **Enumeration date:** 06/15/2016
- **Last updated:** 06/15/2016