Healthcare Provider Details

I. General information

NPI: 1528475977
Provider Name (Legal Business Name): DESERT CHIROPRACTIC SPINAL REHAB & MASSAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2014
Last Update Date: 07/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 KNIGHT ST SUITE B
RICHLAND WA
99352-4258
US

IV. Provider business mailing address

507 KNIGHT ST SUITE B
RICHLAND WA
99352-4258
US

V. Phone/Fax

Practice location:
  • Phone: 509-943-4919
  • Fax: 509-578-1012
Mailing address:
  • Phone: 509-943-4919
  • Fax: 509-578-1012

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: TIFFANY VOPALENSKY
Title or Position: BUSINESS MANAGER
Credential:
Phone: 509-943-4919