Provider Demographics
NPI:1699921593
Name:NYMEYER, BRADLEY A (LAC, LMT)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:A
Last Name:NYMEYER
Suffix:
Gender:M
Credentials:LAC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13051 SW JENKINS RD
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-1314
Mailing Address - Country:US
Mailing Address - Phone:503-927-7909
Mailing Address - Fax:
Practice Address - Street 1:63 TOUCHSTONE
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-1903
Practice Address - Country:US
Practice Address - Phone:503-927-7909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-11
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02713171100000X
OR10989225700000X
OR6010225700000X
ORAC207357171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist