Provider Demographics
NPI:1316627904
Name:MCKINLEY, ADAM JARED CHARLES (LMT)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:JARED CHARLES
Last Name:MCKINLEY
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 78
Mailing Address - Street 2:
Mailing Address - City:SCOTTS MILLS
Mailing Address - State:OR
Mailing Address - Zip Code:97375-0078
Mailing Address - Country:US
Mailing Address - Phone:971-208-3909
Mailing Address - Fax:
Practice Address - Street 1:306 OAK ST
Practice Address - Street 2:
Practice Address - City:SILVERTON
Practice Address - State:OR
Practice Address - Zip Code:97381-1719
Practice Address - Country:US
Practice Address - Phone:503-874-4067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR19439225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist