Organization
GREY FOREST WELLNESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREA LYNN OTKEN DC (PRESIDENT)
(727) 265-0804
Entity
Organization
Contact information
Practice address
795 PIEDMONT AVE NW, SALEM, OR 97304-4308
(727) 265-0804
Mailing address
795 PIEDMONT AVE NW, SALEM, OR 97304-4308
(727) 265-0804
Taxonomy
Speciality
Code
Description
License number
State
111NN1001X
Nutrition Chiropractor
Primary
5644
OR
Other
Enumeration date
06/15/2016
Last updated
06/15/2016
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