Provider Demographics
NPI:1942765698
Name:KRIEG, SAMANTHA JO (DC)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JO
Last Name:KRIEG
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16701 NE HASSALO ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-6111
Mailing Address - Country:US
Mailing Address - Phone:970-640-3440
Mailing Address - Fax:
Practice Address - Street 1:5125 OLYMPIC DR NW STE 110
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1712
Practice Address - Country:US
Practice Address - Phone:253-853-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-07
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60926307111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor