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General NPI Number Information
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NPI Number | 1588597603
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Entity Type | Organization
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Legal Business Name | SLO CRANIAL & MEDICAL MASSAGE, LLC
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Dates
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Enumeration Date | 06/08/2026
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Last Update Date | 06/08/2026
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Provider Practice Location Address
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Address Line | 531 MARSH ST STE A
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-3967
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Country | US
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Telephone | 805-674-1307
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Fax |
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Provider Business Mailing Address
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Address Line | 405 CALLISTO LN
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City | NIPOMO
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State | CA
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Zip | 93444-9656
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Country | US
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Telephone | 805-674-1307
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Fax | 805-619-7191
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Authorized Official
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Title or Position | OWNER
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Name | ELIZABETH C KELLEY
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Credential |
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Telephone | 805-674-1307
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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