NPIMap

Organization Active NPI

Mind Body Spirit LLC

  • Massage Therapist
  • Portland, OR
National Provider Identifier
1538477013
Registry record updated Apr 21, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Massage TherapistTaxonomy code 225700000X
License
17071 Issued in OR
Legal business name
MIND BODY SPIRIT LLC
Practice address
2705 E Burnside St Ste 104
Portland, OR 97214-1767
Phone
(503) 893-4022
NPI assigned
Sep 19, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jon E Dare, LMP, LMTNPI 1902049562
Title
Owner
Phone
(503) 893-4022

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Massage TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225700000X MA60040619 WA
Massage TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225700000X 17071 OR Primary

Addresses

Primary practice location

2705 E Burnside St Ste 104
Portland, OR 97214-1767

Mailing address

2705 E Burnside St Ste 104
Portland, OR 97214-1767
Phone (503) 893-4022

Other names 1

  • Mind Body Spirit - A Holistic Community Doing business as

National Provider Directory

National Provider Directory

Locations

2705 E Burnside St
Ste 104
Portland, OR 97214
Phone (503) 893-4022

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1284854400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1398038400000",
    "number": "1538477013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2705 E BURNSIDE ST STE 104",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972141767",
            "telephone_number": "503-893-4022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2705 E BURNSIDE ST STE 104",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972141767",
            "telephone_number": "503-893-4022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIND BODY SPIRIT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-19",
        "last_updated": "2014-04-21",
        "status": "A",
        "authorized_official_last_name": "DARE",
        "authorized_official_first_name": "JON",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-893-4022",
        "authorized_official_credential": "LMP, LMT"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Massage Therapist",
            "state": "WA",
            "license": "MA60040619",
            "primary": false
        },
        {
            "code": "225700000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Massage Therapist",
            "state": "OR",
            "license": "17071",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mind Body Spirit - A Holistic Community",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Portland, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.