Healthcare Provider Details

I. General information

NPI: 1326767468
Provider Name (Legal Business Name): GRACEFUL WAVES WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2022
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 S MARINE DR
WHEELER OR
97147-0270
US

IV. Provider business mailing address

PO BOX 315
WHEELER OR
97147-0315
US

V. Phone/Fax

Practice location:
  • Phone: 503-368-9355
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. DAWN SEA KAHRS
Title or Position: OWNER
Credential:
Phone: 503-368-9355