Individual
KEITH DENICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1219 SE LAFAYETTE ST, PORTLAND, OR 97202-3802
(503) 765-5733
Mailing address
8143 SE 75TH PL, PORTLAND, OR 97206-8623
(971) 295-6003
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
08/20/2025
Last updated
08/20/2025
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