Individual
JOSHUA PHILLIP NICKELSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3630 SE CESAR E CHAVEZ BLVD APT 11, PORTLAND, OR 97202-1700
(917) 617-4741
Mailing address
3630 SE CESAR E CHAVEZ BLVD APT 11, PORTLAND, OR 97202-1700
(917) 617-4741
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
26433
OR
Other
Enumeration date
10/26/2021
Last updated
10/26/2021
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