MEDICARE: CHRISTOPHER JAY WEISENBORN LMP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MA00018220	WA

General Provider Information

NPI Number	:	1285857953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER JAY WEISENBORN LMP

Provider Business Mailing Address
First Line	:	7904 NE 6TH AVE
Second Line	:	SUITE C
City	:	VANCOUVER
State	:	WA
Zip	:	98665-8150
Country	:	US
Telephone Number	:	360-910-7183
Fax Number	:

Provider Business Practice Location Address
First Line	:	7904 NE 6TH AVE
Second Line	:	SUITE C
City	:	VANCOUVER
State	:	WA
Zip	:	98665-8150
Country	:	US
Telephone Number	:	360-910-7183
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	07/08/2007

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