Provider Demographics
NPI:1003928490
Name:SPRING VALLEY MASSAGE & WELLNESS CENTER,
Entity Type:Organization
Organization Name:SPRING VALLEY MASSAGE & WELLNESS CENTER,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHAE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:OFFICE MANAGER
Authorized Official - Phone:469-241-1294
Mailing Address - Street 1:305 W SPRING CREEK PKWY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023-4626
Mailing Address - Country:US
Mailing Address - Phone:469-241-1294
Mailing Address - Fax:469-241-1760
Practice Address - Street 1:305 W SPRING CREEK PKWY
Practice Address - Street 2:SUITE 103
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-4626
Practice Address - Country:US
Practice Address - Phone:469-241-1294
Practice Address - Fax:469-241-1760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF007130111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0029NCOtherBLUE CROSS BLUE SHIELD