Individual
DEREK CHITTENDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
9370 SW GREENBURG RD, STE 602, PORTLAND, OR 97223-5442
(503) 464-6410
Mailing address
8260 SW FAIRWAY DR, PORTLAND, OR 97225-2754
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
18734
OR
Other
Enumeration date
07/24/2013
Last updated
07/24/2013
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