Healthcare Provider Details

I. General information

NPI: 1023208519
Provider Name (Legal Business Name): COULEE CHIROPRACTIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2007
Last Update Date: 10/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 N ADAMS
COULEE CITY WA
99115
US

IV. Provider business mailing address

PO BOX 817
COULEE CITY WA
99115-0817
US

V. Phone/Fax

Practice location:
  • Phone: 509-632-8668
  • Fax: 509-632-5761
Mailing address:
  • Phone: 509-632-8668
  • Fax: 509-632-5761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH00034180
License Number StateWA

VIII. Authorized Official

Name: TYRONE THOMAS TREXLER
Title or Position: PRESIDENT
Credential: D.C.
Phone: 509-632-8668