Provider Demographics
NPI:1336478932
Name:BODY & MIND MASSAGE INSTITUTE, INC
Entity Type:Organization
Organization Name:BODY & MIND MASSAGE INSTITUTE, INC
Other - Org Name:BODY & MIND SPA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VU
Authorized Official - Middle Name:QUANG
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:808-524-8588
Mailing Address - Street 1:PO BOX 37342
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96837-0342
Mailing Address - Country:US
Mailing Address - Phone:808-524-8588
Mailing Address - Fax:808-356-1707
Practice Address - Street 1:31 S BERETANIA ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2220
Practice Address - Country:US
Practice Address - Phone:808-524-8588
Practice Address - Fax:808-356-1707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-10
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI760111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty