MEDICARE: MRS. CHRISTINE DEANA JEAN DACUS MASSAGE THERAPIST

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	13756	TN

General Provider Information

NPI Number	:	1871213942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHRISTINE DEANA JEAN DACUS MASSAGE THERAPIST

Provider Business Mailing Address
First Line	:	9325 APISON PIKE STE 137
Second Line	:
City	:	OOLTEWAH
State	:	TN
Zip	:	37363-3805
Country	:	US
Telephone Number	:	423-567-1083
Fax Number	:

Provider Business Practice Location Address
First Line	:	9325 APISON PIKE STE 137
Second Line	:
City	:	OOLTEWAH
State	:	TN
Zip	:	37363-3805
Country	:	US
Telephone Number	:	423-567-1083
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2022
Last Update Date	:	08/30/2022

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