Individual
BRUCE JARROD KANDLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMT, MP
Contact information
Practice address
77895 LUPINE LN, WESTON, OR 97886-6006
(541) 566-2725
Mailing address
77895 LUPINE LN, WESTON, OR 97886-6006
(541) 566-2725
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
21472
OR
225700000X
Massage Therapist
Primary
MA 60563683
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21472
MASSAGE THERAPIST
OR
01
—
MA60563683
MASSAGE THERAPIST
WA
Enumeration date
07/21/2015
Last updated
07/21/2015
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