MCHENRY MASSAGE CENTER
NPI 1699953869
Clinic/Center in Mchenry, IL

Active since February 09, 2008CLIA 14D2095180 · Waiver
1307 COURT ST, MCHENRY, IL 60050(815) 385-8190 Get Directions Write a Review

NPPES record last updated: February 9, 2008. Verified against the NPPES registry weekly; last sync: July 19, 2026.

  • Organization
  • Clinic/Center
  • CLIA Number: 14D2095180
  • CLIA Cert. Type: Physician Office
  • CLIA Exp. Date: 04-30-2027

About MCHENRY MASSAGE CENTER

This page provides the complete NPI Profile along with additional information for Mchenry Massage Center, a provider established in Mchenry, Illinois operating as a Clinic/center. The healthcare provider is registered in the NPI registry with number 1699953869 assigned on February 2008. The practitioner's primary taxonomy code is 261Q00000X. The provider is registered as an organization and their NPI record was last updated 18 years ago. The provider's is doing business as Mchenry Massage Center. The authorized official of this NPI record is Mr. Jon R Petersen Lmt (President)

NPI
1699953869 Verify this NPI
Provider Legal Name
NATURAL THERAPY WELLNESS CENTER INC
Other Organization Name
MCHENRY MASSAGE CENTER
Other Name Type
Doing Business As (3)
Entity Type
Organization
Location Address
1307 COURT ST MCHENRY, IL 60050
Location Phone
(815) 385-8190
Mailing Address
1307 COURT ST MCHENRY, IL 60050
Mailing Phone
(815) 385-8190
Is Sole Proprietor?
No
Is Organization Subpart?
No
Enumeration Date
02-09-2008
Last Update Date
02-09-2008
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Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification

Clinic/Center

Taxonomy Code
261Q00000X
Type
Ambulatory Health Care Facilities
License State
IL
Taxonomy Description
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

Authorized Official

The authorized official is the designated individual with the legal authority to make changes to the provider’s official NPI record. For organizations, the authorized official must be a general partner, chairman of the board, CEO, CFO or a direct owner holding at least a 5 percent stake in the medical organization.

Authorized Official Name

MR. JON R PETERSEN LMT

Authorized Official Title
PRESIDENT
Authorized Official Phone
(815) 385-8190

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:

CLIA Number
14D2095180
Facility Type
Physician Office
Certificate Effective Date
May 01, 2025
Certificate Expiration Date
April 30, 2027
Laboratory Director
MATILDA ROSANWO
Certificate Type
Certificate of Waiver
Certificate Type Description
This CLIA certificate is issued to Mchenry Massage Center to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.

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Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1699953869, enumerated as an "organization" on February 09, 2008.

The provider is located at 1307 COURT ST MCHENRY, IL 60050 and the phone number is (815) 385-8190.

Clinic/Center with taxonomy code 261Q00000X.