Healthcare Provider Details

I. General information

NPI: 1104097922
Provider Name (Legal Business Name): ADVANCED SPINE CARE, P.S.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2008
Last Update Date: 03/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 COOPER POINT RD SW SUITE A-1
OLYMPIA WA
98502-1104
US

IV. Provider business mailing address

PO BOX 12955
OLYMPIA WA
98508-2955
US

V. Phone/Fax

Practice location:
  • Phone: 360-754-2915
  • Fax: 360-754-6919
Mailing address:
  • Phone: 360-754-2915
  • Fax: 360-754-6919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. AARON J FITZPATRICK
Title or Position: PRESIDENT/OWNER
Credential: D.C., LMP
Phone: 360-754-2915