Provider Demographics
NPI:1982096517
Name:INNER BALANCE MASSAGE
Entity Type:Organization
Organization Name:INNER BALANCE MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHASITY
Authorized Official - Middle Name:S
Authorized Official - Last Name:SNEDICOR
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:503-939-8304
Mailing Address - Street 1:15895 SW 72ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7977
Mailing Address - Country:US
Mailing Address - Phone:503-939-8304
Mailing Address - Fax:
Practice Address - Street 1:15895 SW 72ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97224-7977
Practice Address - Country:US
Practice Address - Phone:503-939-8304
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-18
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13029302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization