Individual
DAVID JACOB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
2534 SE 35TH AVE, PORTLAND, OR 97202-1502
(503) 522-5550
Mailing address
2534 SE 35TH AVE, PORTLAND, OR 97202-1502
(503) 522-5550
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
14424
OR
Other
Enumeration date
12/10/2007
Last updated
12/10/2007
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