Individual
MAX MIKELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3807 NE KILLINGSWORTH ST, PORTLAND, OR 97211-8021
(971) 420-5105
Mailing address
3807 NE KILLINGSWORTH ST, PORTLAND, OR 97211-8021
(971) 420-5105
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
29343
OR
Other
Enumeration date
11/22/2025
Last updated
11/22/2025
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