MEDICARE: DR. MICHAEL DORNBUSCH D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH00034607	WA

General Provider Information

NPI Number	:	1205837929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL DORNBUSCH D.C.

Provider Business Mailing Address
First Line	:	3307 EVERGREEN WAY
Second Line	:	SUITE 601
City	:	WASHOUGAL
State	:	WA
Zip	:	98671-2062
Country	:	US
Telephone Number	:	360-835-9981
Fax Number	:	360-835-5765

Provider Business Practice Location Address
First Line	:	3307 EVERGREEN WAY
Second Line	:	SUITE 601
City	:	WASHOUGAL
State	:	WA
Zip	:	98671-2062
Country	:	US
Telephone Number	:	360-835-9981
Fax Number	:	360-835-5765

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2005
Last Update Date	:	04/17/2009

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