Provider Demographics
NPI:1760833362
Name:SOARING DRAGON MASSAGE
Entity Type:Organization
Organization Name:SOARING DRAGON MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:HIGHFILL
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:503-442-7177
Mailing Address - Street 1:5505 NE 32ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-6829
Mailing Address - Country:US
Mailing Address - Phone:503-442-7177
Mailing Address - Fax:
Practice Address - Street 1:2143 NE BROADWAY ST
Practice Address - Street 2:STE 1
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1512
Practice Address - Country:US
Practice Address - Phone:503-442-7177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLOAT NORTH LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-06-24
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC174440171100000X
OR16698225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty