Healthcare Provider Details

I. General information

NPI: 1336280262
Provider Name (Legal Business Name): MASSAGE NORTH WEST, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6395 KEIZER STATION BLVD. NE STE. 103
KEIZER OR
97303-2302
US

IV. Provider business mailing address

1775 32ND PLACE NE SUITE B
SALEM OR
97301-8774
US

V. Phone/Fax

Practice location:
  • Phone: 503-589-1597
  • Fax:
Mailing address:
  • Phone: 503-589-1597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL CHENAULT
Title or Position: CEO
Credential:
Phone: 503-589-1597