Provider Demographics
NPI:1356688329
Name:BENJAMIN TIFFANY
Entity Type:Organization
Organization Name:BENJAMIN TIFFANY
Other - Org Name:HEALING BALM MEDICAL MASSAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:TIFFANY
Authorized Official - Suffix:
Authorized Official - Credentials:CMT
Authorized Official - Phone:231-342-8483
Mailing Address - Street 1:PO BOX 486
Mailing Address - Street 2:
Mailing Address - City:WEIMAR
Mailing Address - State:CA
Mailing Address - Zip Code:95736-0486
Mailing Address - Country:US
Mailing Address - Phone:231-342-8483
Mailing Address - Fax:
Practice Address - Street 1:20601 WEST PAOLI LANE
Practice Address - Street 2:
Practice Address - City:WEIMAR
Practice Address - State:CA
Practice Address - Zip Code:95736
Practice Address - Country:US
Practice Address - Phone:231-342-8483
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37419225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty