Healthcare Provider Details

I. General information

NPI: 1487045332
Provider Name (Legal Business Name): VALLEY CHIROPRACTIC AND WELLNESS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2015
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 ROOSEVELT AVE STE 7
MOUNT VERNON WA
98273-2687
US

IV. Provider business mailing address

1420 ROOSEVELT AVE STE 7
MOUNT VERNON WA
98273-2687
US

V. Phone/Fax

Practice location:
  • Phone: 360-941-0505
  • Fax:
Mailing address:
  • Phone: 360-941-0505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH00001908
License Number StateWA

VIII. Authorized Official

Name: DR. LORI DELIGHT JOHNSON
Title or Position: OWNER/DOCTOR OF CHIROPRACTIC
Credential: D.C.
Phone: 360-941-0505