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1255680831
MARK RONALD JOHANSEN
PORTLAND, OR
NPI
1255680831
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
111N00000X Chiropractor
(Licence: OR 5072)
Enumeration Date
2012-08-29
Last Update Date
2012-09-04
Business Address
MARK RONALD JOHANSEN D.C.
12762 SE STARK ST PLAZA 125 BLDG. D
PORTLAND, OR 97233-1539
Phone number: 503-255-7746
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Mailing Address
MARK RONALD JOHANSEN D.C.
14661 SE 172ND AVE
CLACKAMAS, OR 97015-7771
Phone number: 503-998-5314
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