Individual
CHAD ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
5010 NE 33RD AVE, PORTLAND, OR 97211-6946
(503) 984-0552
Mailing address
1544 N HIGHLAND ST, PORTLAND, OR 97217-4824
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
10820
OR
Other
Enumeration date
10/30/2017
Last updated
10/30/2017
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