Provider Demographics
NPI:1922250927
Name:ARC THERAPEUTIC MASSAGE, LLC
Entity Type:Organization
Organization Name:ARC THERAPEUTIC MASSAGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DORA
Authorized Official - Middle Name:DELAINE-WINTER
Authorized Official - Last Name:FURLONG
Authorized Official - Suffix:
Authorized Official - Credentials:LMT, NCTMB
Authorized Official - Phone:816-884-3039
Mailing Address - Street 1:401 GALAXIE AVE
Mailing Address - Street 2:
Mailing Address - City:HARRISONVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64701-2078
Mailing Address - Country:US
Mailing Address - Phone:816-884-3039
Mailing Address - Fax:
Practice Address - Street 1:401 GALAXIE AVE
Practice Address - Street 2:
Practice Address - City:HARRISONVILLE
Practice Address - State:MO
Practice Address - Zip Code:64701-2078
Practice Address - Country:US
Practice Address - Phone:816-884-3039
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO111N00000X
MO2008028618225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty