Provider Demographics
NPI:1528208360
Name:NALANI'S MEDICAL & SPA MASSAGE, INC
Entity Type:Organization
Organization Name:NALANI'S MEDICAL & SPA MASSAGE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:513-205-7597
Mailing Address - Street 1:848 E MITCHELL AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-1416
Mailing Address - Country:US
Mailing Address - Phone:513-205-7597
Mailing Address - Fax:
Practice Address - Street 1:848 E MITCHELL AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-1416
Practice Address - Country:US
Practice Address - Phone:937-212-4771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-05
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.016252172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172M00000XOther Service ProvidersMechanotherapistGroup - Single Specialty