Healthcare Provider Details

I. General information

NPI: 1477859783
Provider Name (Legal Business Name): ASDRUBAL IBARRA LOPEZ D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2011
Last Update Date: 12/19/2022
Certification Date: 12/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 S SULLIVAN RD
SPOKANE VALLEY WA
99037-9754
US

IV. Provider business mailing address

902 S SULLIVAN RD
SPOKANE VALLEY WA
99037-9754
US

V. Phone/Fax

Practice location:
  • Phone: 509-922-1909
  • Fax: 509-922-6648
Mailing address:
  • Phone: 509-922-1909
  • Fax: 509-922-6648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberCH 60205933
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH60205933
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: