Healthcare Provider Details

I. General information

NPI: 1144604968
Provider Name (Legal Business Name): BRIDGE CHIROPRACTIC 4 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2015
Last Update Date: 07/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7317 E MILL PLAIN BLVD
VANCOUVER WA
98664-1300
US

IV. Provider business mailing address

7317 E MILL PLAIN BLVD
VANCOUVER WA
98664-1300
US

V. Phone/Fax

Practice location:
  • Phone: 360-695-4041
  • Fax: 360-693-2490
Mailing address:
  • Phone: 360-695-4041
  • Fax: 360-693-2490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH00003537
License Number StateWA

VIII. Authorized Official

Name: PAUL A REED
Title or Position: OWNER & CHIROPRACTOR
Credential: DC
Phone: 360-574-5944