Provider Demographics
NPI:1952758401
Name:DOCTOR'S CHOICE MEDICAL MASSAGE
Entity Type:Organization
Organization Name:DOCTOR'S CHOICE MEDICAL MASSAGE
Other - Org Name:KAHUNA BODYWORKS OF MONTEREY BAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:B
Authorized Official - Last Name:GUTTENBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:3035-899-9052
Mailing Address - Street 1:910 MAJOR SHERMAN LN
Mailing Address - Street 2:UNIT 200
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-4642
Mailing Address - Country:US
Mailing Address - Phone:831-708-8722
Mailing Address - Fax:
Practice Address - Street 1:910 MAJOR SHERMAN LN
Practice Address - Street 2:UNIT 200
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-4642
Practice Address - Country:US
Practice Address - Phone:831-708-8722
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-14
Last Update Date:2016-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35418172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172M00000XOther Service ProvidersMechanotherapistGroup - Multi-Specialty