Healthcare Provider Details

I. General information

NPI: 1407178080
Provider Name (Legal Business Name): DONNA MARIA ARCHER, DC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2010
Last Update Date: 02/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5512 NE 109TH CT SUITE A
VANCOUVER WA
98662-6175
US

IV. Provider business mailing address

5512 NE 109TH CT. SUITE A
VANCOUVER WA
98662-6175
US

V. Phone/Fax

Practice location:
  • Phone: 360-885-4715
  • Fax: 360-859-3741
Mailing address:
  • Phone: 360-885-4715
  • Fax: 360-859-3741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH00033998
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60133357
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60127460
License Number StateWA

VIII. Authorized Official

Name: DR. DONNA MARIA ARCHER
Title or Position: OWNER
Credential: D.C.
Phone: 360-885-4715