Provider Demographics
NPI:1154794154
Name:COREY GEFFKEN LMP
Entity type:Organization
Organization Name:COREY GEFFKEN LMP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COREYT
Authorized Official - Middle Name:
Authorized Official - Last Name:GEFFKEN
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:206-321-6033
Mailing Address - Street 1:345 WESTFIELD ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SILVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97381-1936
Mailing Address - Country:US
Mailing Address - Phone:206-321-6033
Mailing Address - Fax:503-874-4478
Practice Address - Street 1:421 N WATER ST
Practice Address - Street 2:SUITE 102
Practice Address - City:SILVERTON
Practice Address - State:OR
Practice Address - Zip Code:97381-1645
Practice Address - Country:US
Practice Address - Phone:206-321-6033
Practice Address - Fax:503-874-4478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-12
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00010746172M00000X
OR18694225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No172M00000XOther Service ProvidersMechanotherapistGroup - Multi-Specialty