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Suppliers Prosthetic/Orthotic Supplier

Provider NPI: 1023188778

Organization Information:
Organization is not Subpart
Authorized Official:  DAVE ALFRED JANKE  PRESIDENT  503-252-5100

Practice Location:
173 NE 102ND AVE  PORTLAND, OR 97220-4169 US
Tel: 503-252-5100  Fax: 503-253-8086

Business Mailing Address:
173 NE 102ND AVE  PORTLAND, OR 97220-4169 US
Tel: 503-252-5100  Fax: 503-253-8086

NPI Information:
NPI: 1023188778
Entity Type: Organization


PrimaryCodeCategory/DescriptionStateLicense Number
Prosthetic/Orthotic Supplier

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 335E00000X





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