MEDICARE: SOUL'S EQUILIBRIUM, LLC

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

General Provider Information

NPI Number	:	1811847452
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUL'S EQUILIBRIUM, LLC

Provider Business Mailing Address
First Line	:	5520 S MACADAM AVE STE 150
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97239-3782
Country	:	US
Telephone Number	:	503-751-3751
Fax Number	:

Provider Business Practice Location Address
First Line	:	5520 S MACADAM AVE STE 150
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97239-3782
Country	:	US
Telephone Number	:	503-751-3751
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	CHRISTINE NICHOLAS-JENANI
Credential	:	LMT
Telephone Number	:	415-595-4997

Provider Enumeration Date	:	02/02/2026
Last Update Date	:	02/02/2026

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Directions to “SOUL'S EQUILIBRIUM, LLC ” Practice Location

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