Provider Demographics
NPI:1679640213
Name:MICHAEL MASS CHIROPRACTIC, INC
Entity Type:Organization
Organization Name:MICHAEL MASS CHIROPRACTIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:F
Authorized Official - Last Name:MASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-889-4197
Mailing Address - Street 1:2075 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OR
Mailing Address - Zip Code:97914-4148
Mailing Address - Country:US
Mailing Address - Phone:541-889-4197
Mailing Address - Fax:541-889-4197
Practice Address - Street 1:2075 SUNSET DR
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-4148
Practice Address - Country:US
Practice Address - Phone:541-889-4197
Practice Address - Fax:541-889-4197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11336111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC011336Medicare ID - Type UnspecifiedGROUP