Provider Demographics
NPI:1477923969
Name:THE UPCOUNTRY MASSAGE CO,LLC
Entity Type:Organization
Organization Name:THE UPCOUNTRY MASSAGE CO,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRINCIPAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHELLE 'NIKKI'
Authorized Official - Middle Name:
Authorized Official - Last Name:JANSSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:808-572-5959
Mailing Address - Street 1:PO BOX 692
Mailing Address - Street 2:
Mailing Address - City:KULA
Mailing Address - State:HI
Mailing Address - Zip Code:96790-0692
Mailing Address - Country:US
Mailing Address - Phone:808-572-5959
Mailing Address - Fax:808-572-0394
Practice Address - Street 1:7 AEWA PL STE 12
Practice Address - Street 2:
Practice Address - City:MAKAWAO
Practice Address - State:HI
Practice Address - Zip Code:96768-8882
Practice Address - Country:US
Practice Address - Phone:808-572-5959
Practice Address - Fax:808-572-0394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-28
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty