| Organization Name: | THE SPA AT PACIFIC WELLNESS, LLC |
| NPI Number: | 1972884302 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | EDWARD DEAN CORLEY (CHIROPRACTOR/OWNER) |
| Mailing Address: | 4114 Bridgeport Way W University Place |
| State: | WA US |
| Postal Code: | 984664303 |
| Phone Number: | 2535644508 |
| Fax Number: | 2535648387 |
| NPI Enumeration Date: | 08/30/2011 |
| NPI Last Update Date: | 08/30/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225700000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Massage Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |