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General NPI Number Information
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NPI Number | 1326767468
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Entity Type | Organization
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Legal Business Name | GRACEFUL WAVES WELLNESS CENTER
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Dates
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Enumeration Date | 08/23/2022
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Last Update Date | 08/23/2022
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Provider Practice Location Address
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Address Line | 206 S MARINE DR
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City | WHEELER
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State | OR
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Zip | 97147-0270
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Country | US
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Telephone | 503-368-9355
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 315
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City | WHEELER
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State | OR
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Zip | 97147-0315
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAWN SEA KAHRS
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Credential |
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Telephone | 503-368-9355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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