1861479230 NPI number — JANINE K KREBS DPT

Table of content: JANINE K KREBS DPT (NPI 1861479230)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861479230 NPI number — JANINE K KREBS DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KREBS
Provider First Name:
JANINE
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WILLIS
Provider Other First Name:
JANINE
Provider Other Middle Name:
K
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1861479230
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 12686
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALEM
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97309
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-540-8701
Provider Business Mailing Address Fax Number:
503-371-8772

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
685 36TH AVE NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALEM
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-371-8860
Provider Business Practice Location Address Fax Number:
503-371-9299
Provider Enumeration Date:
12/28/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  4964 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)