Organization
PRN MEDICAL MASSAGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHIP DALE SMITH MMP, HE, ANMT, CMT (OWNER)
(707) 527-7959
Entity
Organization
Contact information
Practice address
455 DONNA DRIVE, WINDSOR, CA 95492-9636
(707) 527-7959
(707) 527-7959
Mailing address
P.O. BOX 18, FULTON, CA 95439-0018
(707) 527-7959
(707) 527-7959
Taxonomy
Speciality
Code
Description
License number
State
273Y00000X
Rehabilitation Hospital Unit
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NONE
NO OTHER IDENTIFIER
CA
Enumeration date
09/13/2021
Last updated
09/13/2021
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