MEDICARE: HIMALAYAN BODY WORKS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063121085
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HIMALAYAN BODY WORKS, LLC

Provider Business Mailing Address
First Line	:	2270 CHAPMAN HILL DR NW
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97304-2541
Country	:	US
Telephone Number	:	503-877-2805
Fax Number	:	971-600-9079

Provider Business Practice Location Address
First Line	:	2367 STATE ST STE 100
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97301-4505
Country	:	US
Telephone Number	:	503-568-2854
Fax Number	:	971-600-9079

Authorized Official
Title or Position	:	MEMBER
Name	:	BLAKE DUNHAM
Credential	:	LMT
Telephone Number	:	971-375-6950

Provider Enumeration Date	:	11/17/2022
Last Update Date	:	02/04/2025

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Directions to “HIMALAYAN BODY WORKS, LLC ” Practice Location

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