# CANNON BEACH SPA INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134383920
- **Authorized official:** DR. TIMOTHY J KRUPA DC (OWNER)
- **Authorized official phone:** (503) 436-8772

## Contact information

- **Practice address:** 232 N SPRUCE ST, CANNON BEACH, OR 97110
- **Practice address phone:** (503) 436-8772
- **Mailing address:** PO BOX 953, CANNON BEACH, OR 97110-0953
- **Mailing address phone:** (503) 436-8772

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QP2000X | Physical Therapy Clinic/Center | 1458 | OR | Yes |

## Other

- **Enumeration date:** 07/11/2008
- **Last updated:** 07/11/2008