Healthcare Provider Details

I. General information

NPI: 1205250958
Provider Name (Legal Business Name): SAWVELL FAMILY CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2014
Last Update Date: 02/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MAIN ST.
BUCKLEY WA
98321
US

IV. Provider business mailing address

PO BOX 194
BUCKLEY WA
98321-0194
US

V. Phone/Fax

Practice location:
  • Phone: 360-829-0610
  • Fax:
Mailing address:
  • Phone: 360-829-0610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberCH60212280
License Number StateWA

VIII. Authorized Official

Name: KRISTINA MICHELLE MAHAN-SAWVELL
Title or Position: OWNER
Credential: DC
Phone: 360-829-0610