Healthcare Provider Details

I. General information

NPI: 1760417315
Provider Name (Legal Business Name): COLUMBIA BASIN CHIROPRACTIC CARE P.S.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 ALDER ST NW
EPHRATA WA
98823-1663
US

IV. Provider business mailing address

51 ALDER ST NW
EPHRATA WA
98823-1663
US

V. Phone/Fax

Practice location:
  • Phone: 509-754-3295
  • Fax: 509-754-3296
Mailing address:
  • Phone: 509-754-3295
  • Fax: 509-754-3296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH00003320
License Number StateWA

VIII. Authorized Official

Name: DR. BRENT LOUIS BEDFORD
Title or Position: OWNER
Credential: D.C.
Phone: 509-754-3295