MEDICARE: CASCADE CHIROPRACTIC, INC., P.S.

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	CH00002803	WA

General Provider Information

NPI Number	:	1760541270
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CASCADE CHIROPRACTIC, INC., P.S.

Provider Business Mailing Address
First Line	:	1217 4TH AVE E STE 200
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98506-4246
Country	:	US
Telephone Number	:	360-570-8151
Fax Number	:	360-943-6602

Provider Business Practice Location Address
First Line	:	1217 4TH AVE E STE 200
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98506-4246
Country	:	US
Telephone Number	:	360-570-8151
Fax Number	:	360-943-6602

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. ROY CLARK EVANS
Credential	:	D.C.
Telephone Number	:	360-570-8151

Provider Enumeration Date	:	12/08/2006
Last Update Date	:	10/21/2011

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