Provider Demographics
NPI:1336684877
Name:KIRK S. JEPSEN
Entity Type:Organization
Organization Name:KIRK S. JEPSEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:JEPSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:971-388-6366
Mailing Address - Street 1:3187 MARCIA DR NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-8647
Mailing Address - Country:US
Mailing Address - Phone:971-388-6366
Mailing Address - Fax:
Practice Address - Street 1:3187 MARCIA DR NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-8647
Practice Address - Country:US
Practice Address - Phone:971-388-6366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-19
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15571174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty