Provider Demographics
NPI:1043479793
Name:PJ KOLKER LLC DBA THE BLUE GIRAFFE DAY SPA
Entity type:Organization
Organization Name:PJ KOLKER LLC DBA THE BLUE GIRAFFE DAY SPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN COORDINATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ROUTZON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-488-3335
Mailing Address - Street 1:51 WATER ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-1841
Mailing Address - Country:US
Mailing Address - Phone:541-488-3335
Mailing Address - Fax:541-488-3337
Practice Address - Street 1:51 WATER ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1841
Practice Address - Country:US
Practice Address - Phone:541-488-3335
Practice Address - Fax:541-488-3337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-07
Last Update Date:2008-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3494111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Multi-Specialty