Provider Demographics
NPI:1457660334
Name:AI ZEN LLC
Entity type:Organization
Organization Name:AI ZEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARTERS
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:503-431-1414
Mailing Address - Street 1:19000 NW EVERGREEN PKWY APT 266
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-7047
Mailing Address - Country:US
Mailing Address - Phone:503-431-1414
Mailing Address - Fax:
Practice Address - Street 1:7689 SW CAPITOL HWY
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-2475
Practice Address - Country:US
Practice Address - Phone:503-791-2394
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR16334225700000X
OR16178225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty