NPI 1124571823

Brian Paul Royal Vanwyngarden, LMT

Practitioner Contractor Salem, OR

Practice location

Address: 2416 13th St SE, Salem, OR 97302-2546
Phone: (503) 798-2918
Mailing address: 435 21st St SE, Salem, OR 97301-8848

Registered specialties

Contractor Primary

Other Service Providers Taxonomy 171W00000X Licence 21790 (OR)

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Registry record

NPI: 1124571823
Entity type: Individual
Sex (as registered): Male
NPI issued: 28 Jul 2016
Record last updated: 28 Jul 2016

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.