Healthcare Provider Details

I. General information

NPI: 1568651636
Provider Name (Legal Business Name): WARNINGER CHIROPRACTIC CLINIC - SELAH OFFICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2007
Last Update Date: 10/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 E 1ST AVE SUITE 1
SELAH WA
98942-1400
US

IV. Provider business mailing address

9 E 1ST AVE SUITE 1
SELAH WA
98942-1400
US

V. Phone/Fax

Practice location:
  • Phone: 509-697-4838
  • Fax:
Mailing address:
  • Phone: 509-697-4838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1002
License Number StateWA

VIII. Authorized Official

Name: RONALD WARNINGER
Title or Position: OWNER
Credential: D.C.
Phone: 509-697-4838