Healthcare Provider Details

I. General information

NPI: 1295360147
Provider Name (Legal Business Name): CHIRO ONE WELLNESS CENTER OF MILL PLAIN PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2020
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7317 E MILL PLAIN BLVD
VANCOUVER WA
98664-1300
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 360-695-4041
  • Fax:
Mailing address:
  • Phone: 630-468-1824
  • 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: 630-229-4430