Individual
KAITLIN WILLOUGHBY BERGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
L.M.T.
Contact information
Practice address
118 N KILLINGSWORTH ST, PORTLAND, OR 97217-2435
(503) 288-4454
(503) 288-1783
Mailing address
513 NE WEBSTER ST, PORTLAND, OR 97211-3807
(786) 473-3854
Taxonomy
Speciality
Code
Description
License number
State
111NR0400X
Rehabilitation Chiropractor
Primary
LMT# 18506
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18506
LMT
OR
Enumeration date
01/13/2012
Last updated
01/13/2012
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