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General NPI Number Information
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NPI Number | 1881009587
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Entity Type | Organization
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Legal Business Name | MY NECK 2 MY BACK MASSAGE
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Dates
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Enumeration Date | 06/23/2014
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Last Update Date | 06/23/2014
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Provider Practice Location Address
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Address Line | 42 N SUTTER ST STE 500
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City | STOCKTON
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State | CA
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Zip | 95202-2913
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Country | US
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Telephone | 209-952-5614
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Fax | 209-242-2654
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Provider Business Mailing Address
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Address Line | PO BOX 436
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City | STOCKTON
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State | CA
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Zip | 95201-0436
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Country | US
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Telephone | 209-952-5614
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Fax | 209-242-2654
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Authorized Official
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Title or Position | OWNER
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Name | MISS LAQUIA MONIQUE JENKINS
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Credential | C.M.T.
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Telephone | 209-952-5614
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172M00000X
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Taxonomy Name | Mechanotherapist
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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 | 173C00000X
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Taxonomy Name | Reflexologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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