Healthcare Provider Details

I. General information

NPI: 1710344957
Provider Name (Legal Business Name): PAUL A RAMOS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2016
Last Update Date: 01/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22910 E APPLEWAY AVE STE 7
LIBERTY LAKE WA
99019-8606
US

IV. Provider business mailing address

22910 E APPLEWAY AVE STE 7
LIBERTY LAKE WA
99019-8606
US

V. Phone/Fax

Practice location:
  • Phone: 509-279-2590
  • Fax: 509-242-0913
Mailing address:
  • Phone: 509-279-2590
  • Fax: 509-242-0913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number603375322
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number603375322
License Number StateWA

VIII. Authorized Official

Name: DR. PAUL ADAM RAMOS
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 509-279-2590