Healthcare Provider Details

I. General information

NPI: 1235642745
Provider Name (Legal Business Name): MARYANN GENESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2017
Last Update Date: 11/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

258 A ST STE 8
ASHLAND OR
97520-1990
US

IV. Provider business mailing address

PO BOX 1166
ASHLAND OR
97520-0039
US

V. Phone/Fax

Practice location:
  • Phone: 541-324-9736
  • Fax: 541-708-6261
Mailing address:
  • Phone: 541-324-9736
  • Fax: 541-708-6261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3770
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC160346
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number3762
License Number StateOR

VIII. Authorized Official

Name: DR. MARYANN GENESS
Title or Position: SOLE PROPRIETOR
Credential: DC
Phone: 541-324-9736