Provider Demographics
NPI:1316257306
Name:JAKWAY CORPORATION DBA ENERGIA BODY CENTRE
Entity type:Organization
Organization Name:JAKWAY CORPORATION DBA ENERGIA BODY CENTRE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:FAVERTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-917-7524
Mailing Address - Street 1:137 LORIMER ST
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-2021
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:760 DEL MONTE CTR
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-6167
Practice Address - Country:US
Practice Address - Phone:831-642-0222
Practice Address - Fax:831-642-4601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-08
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty