Provider Demographics
NPI:1922744705
Name:BODY CRAFT WELLNESS LLC
Entity type:Organization
Organization Name:BODY CRAFT WELLNESS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:HAYLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-349-6221
Mailing Address - Street 1:1135 SE SALMON ST.
Mailing Address - Street 2:SUITE 108
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214
Mailing Address - Country:US
Mailing Address - Phone:503-349-6221
Mailing Address - Fax:503-907-9117
Practice Address - Street 1:1135 SE SALMON ST.
Practice Address - Street 2:SUITE 108
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214
Practice Address - Country:US
Practice Address - Phone:503-349-6221
Practice Address - Fax:503-907-9117
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BODY CRAFT WELLNESS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-05-05
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500783369Medicaid