Provider Demographics
NPI:1992159958
Name:HUN, ADAN (LMT)
Entity type:Individual
Prefix:MR
First Name:ADAN
Middle Name:
Last Name:HUN
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 1:3903 SANTIAM PASS WAY NE
Mailing Address - Street 2:#207
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97305-6817
Mailing Address - Country:US
Mailing Address - Phone:503-510-8426
Mailing Address - Fax:
Practice Address - Street 1:16088 BOONES FERRY RD
Practice Address - Street 2:STE B
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-4370
Practice Address - Country:US
Practice Address - Phone:503-376-6928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-15
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13696225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist