Provider Demographics
NPI:1255647004
Name:TRANQUIL HEATLH MASSAGE & WELLNESS CENTER, LLC
Entity type:Organization
Organization Name:TRANQUIL HEATLH MASSAGE & WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GAYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINCHICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-218-5909
Mailing Address - Street 1:8110 THREE EAGLES DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-9359
Mailing Address - Country:US
Mailing Address - Phone:970-218-5909
Mailing Address - Fax:
Practice Address - Street 1:3307 S COLLEGE AVE
Practice Address - Street 2:200-8
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-4196
Practice Address - Country:US
Practice Address - Phone:970-218-5909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-30
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2105225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty