Organization
MIND BODY SPIRIT LLC
Active
Other names
Mind Body Spirit - A Holistic Community
Organization subpart
No
Provider details
NPI number
Authorized official
JON E DARE LMP, LMT (OWNER)
(503) 893-4022
Entity
Organization
Contact information
Practice address
2705 E BURNSIDE ST STE 104, PORTLAND, OR 97214-1767
(503) 893-4022
Mailing address
2705 E BURNSIDE ST STE 104, PORTLAND, OR 97214-1767
(503) 893-4022
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
17071
OR
225700000X
Massage Therapist
MA60040619
WA
Other
Enumeration date
09/19/2010
Last updated
04/21/2014
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