MEDICARE: MASSAGE COMFORT AND SPA INC

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	111N00000X	Chiropractor
2	225700000X	Massage Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	023275	OTHER	OR	STATE LICENSE

General Provider Information

NPI Number	:	1063155257
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MASSAGE COMFORT AND SPA INC

Provider Business Mailing Address
First Line	:	4878 SE POLLARD PL
Second Line	:
City	:	MILWAUKIE
State	:	OR
Zip	:	97222-3253
Country	:	US
Telephone Number	:	503-793-8676
Fax Number	:

Provider Business Practice Location Address
First Line	:	480 5TH ST
Second Line	:
City	:	LAKE OSWEGO
State	:	OR
Zip	:	97034-3079
Country	:	US
Telephone Number	:	503-793-8676
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DAVE STEELE
Credential	:
Telephone Number	:	503-793-8676

Provider Enumeration Date	:	04/15/2022
Last Update Date	:	09/14/2024

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Directions to “MASSAGE COMFORT AND SPA INC ” Practice Location

Language	Start Address	Practice Location

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