Provider Demographics
NPI:1023807039
Name:CHEHALEM VALLEY MASSAGE
Entity type:Organization
Organization Name:CHEHALEM VALLEY MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSE MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LACY
Authorized Official - Middle Name:
Authorized Official - Last Name:TAGHON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-944-5104
Mailing Address - Street 1:915 E 9TH ST
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-3555
Mailing Address - Country:US
Mailing Address - Phone:231-944-5104
Mailing Address - Fax:
Practice Address - Street 1:2119 E PORTLAND RD
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-1362
Practice Address - Country:US
Practice Address - Phone:231-944-5104
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty