Healthcare Provider Details

I. General information

NPI: 1194350041
Provider Name (Legal Business Name): CHIRO ONE WELLNESS CENTER OF DOWNTOWN VANCOUVER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2020
Last Update Date: 03/10/2020
Certification Date: 03/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 BROADWAY ST UNIT 200
VANCOUVER WA
98660-3296
US

IV. Provider business mailing address

2625 BUTTERFIELD RD STE 301N
OAK BROOK IL
60523-1266
US

V. Phone/Fax

Practice location:
  • Phone: 360-828-1574
  • Fax:
Mailing address:
  • Phone: 630-229-4430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: AMY MORAN
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 630-220-4430