Individual
JAY KROKENBERGER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
1010 13TH ST SE, SALEM, OR 97302-2507
(971) 361-6070
Mailing address
1010 13TH ST SE, SALEM, OR 97302-2507
(971) 361-6070
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
21156
OR
Other
Enumeration date
02/14/2016
Last updated
10/01/2018
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