Provider Demographics
NPI:1881009587
Name:MY NECK 2 MY BACK MASSAGE
Entity Type:Organization
Organization Name:MY NECK 2 MY BACK MASSAGE
Other - Org Name:LAQUIA MONIQUE JENKINS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:LAQUIA
Authorized Official - Middle Name:MONIQUE
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:CMT
Authorized Official - Phone:209-952-5614
Mailing Address - Street 1:PO BOX 436
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95201-0436
Mailing Address - Country:US
Mailing Address - Phone:209-952-5614
Mailing Address - Fax:209-242-2654
Practice Address - Street 1:42 N SUTTER ST
Practice Address - Street 2:STE 500
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-2913
Practice Address - Country:US
Practice Address - Phone:209-952-5614
Practice Address - Fax:209-242-2654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-23
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty
No172M00000XOther Service ProvidersMechanotherapistGroup - Single Specialty
No173C00000XOther Service ProvidersReflexologistGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty