Provider Demographics
NPI:1164853677
Name:FIBROMYALGIA AND NEUROMUSCULAR PAIN CENTER OF OREGON
Entity Type:Organization
Organization Name:FIBROMYALGIA AND NEUROMUSCULAR PAIN CENTER OF OREGON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:KLERONOMOS
Authorized Official - Suffix:
Authorized Official - Credentials:DAOM, FNP
Authorized Official - Phone:425-318-0300
Mailing Address - Street 1:700 BELLEVUE ST SE
Mailing Address - Street 2:SUITE 225
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3819
Mailing Address - Country:US
Mailing Address - Phone:844-724-6789
Mailing Address - Fax:844-724-6789
Practice Address - Street 1:700 BELLEVUE ST SE
Practice Address - Street 2:SUITE 225
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3819
Practice Address - Country:US
Practice Address - Phone:844-724-6789
Practice Address - Fax:844-724-6789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-09
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty