Healthcare Provider Details

I. General information

NPI: 1598062242
Provider Name (Legal Business Name): CARCON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2011
Last Update Date: 02/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16078 SW TUALATIN SHERWOOD RD
SHERWOOD OR
97140-8522
US

IV. Provider business mailing address

16078 SW TUALATIN SHERWOOD RD
SHERWOOD OR
97140-8522
US

V. Phone/Fax

Practice location:
  • Phone: 503-625-0100
  • Fax: 503-625-0301
Mailing address:
  • Phone: 503-625-0100
  • Fax: 503-625-0301

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. STEVE J NORRIS
Title or Position: PRESIDENT
Credential:
Phone: 503-625-0100