Provider Demographics
NPI:1336280262
Name:MASSAGE NORTH WEST, INC.
Entity Type:Organization
Organization Name:MASSAGE NORTH WEST, INC.
Other - Org Name:MASSAGE ENVY OF KEIZER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CHENAULT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-589-1597
Mailing Address - Street 1:1775 32ND PLACE NE
Mailing Address - Street 2:SUITE B
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-8774
Mailing Address - Country:US
Mailing Address - Phone:503-589-1597
Mailing Address - Fax:
Practice Address - Street 1:6395 KEIZER STATION BLVD. NE
Practice Address - Street 2:STE. 103
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303-2302
Practice Address - Country:US
Practice Address - Phone:503-589-1597
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty