MEDICARE: ACTION POTENTIAL CHIROPRACTIC INC. PS

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	CH00002070	WA

General Provider Information

NPI Number	:	1821250457
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACTION POTENTIAL CHIROPRACTIC INC. PS

Provider Business Mailing Address
First Line	:	848 N SUNRISE BLVD STE 102 BLD A
Second Line	:
City	:	CAMANO ISLAND
State	:	WA
Zip	:	98282
Country	:	US
Telephone Number	:	360-629-2524
Fax Number	:	360-610-4979

Provider Business Practice Location Address
First Line	:	848 N SUNRISE BLVD STE 102 BLD A
Second Line	:
City	:	CAMANO ISLAND
State	:	WA
Zip	:	98282-8833
Country	:	US
Telephone Number	:	360-629-2524
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RAY POPE
Credential	:	D.C.
Telephone Number	:	360-629-2524

Provider Enumeration Date	:	06/25/2008
Last Update Date	:	02/20/2019

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