Provider Demographics
NPI:1750449963
Name:ANCIENT WAY MASSAGE
Entity Type:Organization
Organization Name:ANCIENT WAY MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:CONARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-672-7335
Mailing Address - Street 1:235 W LOOCKERMAN ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-3247
Mailing Address - Country:US
Mailing Address - Phone:302-672-7335
Mailing Address - Fax:302-672-9060
Practice Address - Street 1:235 W LOOCKERMAN ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-3247
Practice Address - Country:US
Practice Address - Phone:302-672-7335
Practice Address - Fax:302-672-9060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE07 00008348171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty