Healthcare Provider Details

I. General information

NPI: 1295793636
Provider Name (Legal Business Name): C J BARTNESS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 08/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 12TH AVE
LONGVIEW WA
98632-2403
US

IV. Provider business mailing address

1060 HUDSON ST
LONGVIEW WA
98632-3103
US

V. Phone/Fax

Practice location:
  • Phone: 360-636-2470
  • Fax: 360-636-5009
Mailing address:
  • Phone: 360-636-2470
  • Fax: 360-423-9320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number974
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: