Provider Demographics
NPI:1124616057
Name:OREGON MASSAGE CLINIC
Entity type:Organization
Organization Name:OREGON MASSAGE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:FENNERN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-538-0100
Mailing Address - Street 1:901 N BRUTSCHER ST STE 208
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-6097
Mailing Address - Country:US
Mailing Address - Phone:503-538-0100
Mailing Address - Fax:971-832-8270
Practice Address - Street 1:901 N BRUTSCHER ST STE 208
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-6097
Practice Address - Country:US
Practice Address - Phone:503-538-0100
Practice Address - Fax:971-832-8270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-06
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty