Individual
JACOB DANIEL BRUNS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
322 NW 5TH AVE STE 305, PORTLAND, OR 97209-3828
(503) 227-0206
Mailing address
1130 NE 1ST AVE APT 102, PORTLAND, OR 97232-2061
(503) 502-2395
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
20831
OR
Other
Enumeration date
11/08/2014
Last updated
10/07/2015
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