Healthcare Provider Details

I. General information

NPI: 1992095814
Provider Name (Legal Business Name): CRAIG D. ANGLESEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2011
Last Update Date: 04/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S PINES RD
SPOKANE VALLEY WA
99206-5324
US

IV. Provider business mailing address

500 S PINES RD
SPOKANE VALLEY WA
99206-5324
US

V. Phone/Fax

Practice location:
  • Phone: 509-927-8881
  • Fax: 509-891-6281
Mailing address:
  • Phone: 509-927-8881
  • Fax: 509-891-6281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH34347
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00022059
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00014642
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60093374
License Number StateWA

VIII. Authorized Official

Name: CRAIG DAVID ANGLESEY
Title or Position: OWNER/CHIROPRACTOR
Credential: D.C.
Phone: 509-927-8881