Organization
JACKIE'S BEAUTY SUPPLY, LLC
Active
Other names
The J Spa
Organization subpart
No
Provider details
NPI number
Authorized official
JACQUELINE JOHNSON LMT (OWNER)
(541) 423-7009
Entity
Organization
Contact information
Practice address
485 ALEXANDER LOOP STE 110, EUGENE, OR 97401-6753
(541) 423-7009
Mailing address
PO BOX 21112, EUGENE, OR 97402-0356
(541) 423-7009
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
19559
OR
Other
Enumeration date
11/06/2017
Last updated
10/08/2019
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