Provider Demographics
NPI:1497407209
Name:KIERES, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:KIERES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15301 SE ROYER RD
Mailing Address - Street 2:
Mailing Address - City:DAMASCUS
Mailing Address - State:OR
Mailing Address - Zip Code:97089-8736
Mailing Address - Country:US
Mailing Address - Phone:971-645-3736
Mailing Address - Fax:
Practice Address - Street 1:15301 SE ROYER RD
Practice Address - Street 2:
Practice Address - City:DAMASCUS
Practice Address - State:OR
Practice Address - Zip Code:97089-8736
Practice Address - Country:US
Practice Address - Phone:971-645-3736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-23
Last Update Date:2022-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist