Healthcare Provider Details

I. General information

NPI: 1356252027
Provider Name (Legal Business Name): MICHAEL SHIELDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1712 WILLAMETTE ST
EUGENE OR
97401-4045
US

IV. Provider business mailing address

329 S 70TH PL
SPRINGFIELD OR
97478-7486
US

V. Phone/Fax

Practice location:
  • Phone: 541-729-1937
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number29820
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: