Individual
MARK RONALD JOHANSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
12762 SE STARK ST, PLAZA 125 BLDG. D, PORTLAND, OR 97233-1539
(503) 255-7746
Mailing address
14661 SE 172ND AVE, CLACKAMAS, OR 97015-7771
(503) 998-5314
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
5072
OR
Other
Enumeration date
08/29/2012
Last updated
09/04/2012
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