Individual
TAVIS M JOHANSSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
6018 SE STARK ST, SUITE 103, PORTLAND, OR 97215-1990
(503) 808-9145
(503) 473-8085
Mailing address
6018 SE STARK ST, SUITE 103, PORTLAND, OR 97215-1990
(503) 808-9145
(503) 473-8085
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
5139
OR
Other
Enumeration date
04/30/2013
Last updated
04/30/2013
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