Provider Demographics
NPI:1215364732
Name:KAIROS, JOSEPH (LMT)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:KAIROS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8826 SE 16TH PL
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-1387
Mailing Address - Country:US
Mailing Address - Phone:503-575-8120
Mailing Address - Fax:
Practice Address - Street 1:833 SE MAIN ST
Practice Address - Street 2:SUITE 108
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-3454
Practice Address - Country:US
Practice Address - Phone:503-575-8120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-28
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17170225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR17170OtherLMT #