Grey Forest Wellness LLC

Primary specialty

Nutrition ChiropractorTaxonomy code 111NN1001X

License

5644 Issued in OR

Legal business name

GREY FOREST WELLNESS LLC

Practice address

795 Piedmont Ave NW
Salem, OR 97304-4308

Phone

(727) 265-0804

NPI assigned

Jun 15, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Andrea Lynn Otken, DCNPI 1972984755

Title

President

Phone

(727) 265-0804

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Andrea Lynn Otken, DC

  • Chiropractor
  • Salem, OR
  • NPI 1972984755
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1465948800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1465948800000",
    "number": "1053761544",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "795 PIEDMONT AVE NW",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973044308",
            "telephone_number": "727-265-0804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "795 PIEDMONT AVE NW",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973044308",
            "telephone_number": "727-265-0804"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREY FOREST WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-15",
        "last_updated": "2016-06-15",
        "status": "A",
        "authorized_official_last_name": "OTKEN",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "727-265-0804",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111NN1001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor, Nutrition",
            "state": "OR",
            "license": "5644",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kenneth Thomas Gregston II
• Melissa Grens
• Gresham Assisted Living LLC (Huntington Terrace Assisted Living Residence)
• Chuck Gress
• Meera J Grewal, D.D.S.
• Debralee Grey, M.S., CCC-SLP
• Abigail Susana Griego, LPC- ASSOCIATE
• Brianna Griffin, LPN
• Elizabeth Graves Griffin, F.N.P.
• Stacy Griffin

• Nutrition Chiropractor in Salem, OR
• Providers in Salem, OR by specialty
• Nutrition Chiropractor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.