Provider Demographics
NPI:1427447911
Name:ENTERADRIAN ORTHOPEDIC MASSAGE & CRANIOSACRAL
Entity type:Organization
Organization Name:ENTERADRIAN ORTHOPEDIC MASSAGE & CRANIOSACRAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:SKEELS
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:517-266-1011
Mailing Address - Street 1:1542 W MAPLE AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-1392
Mailing Address - Country:US
Mailing Address - Phone:517-266-1011
Mailing Address - Fax:517-266-1011
Practice Address - Street 1:1542 W MAPLE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1392
Practice Address - Country:US
Practice Address - Phone:517-266-1011
Practice Address - Fax:517-266-1011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI=========OtherSTATE OF MICHIGAN