Healthcare Provider Details

I. General information

NPI: 1467919431
Provider Name (Legal Business Name): SHERRY WANG LEAVITT DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2019
Last Update Date: 10/07/2020
Certification Date: 10/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11015 NE FOURTH PLAIN BLVD STE B
VANCOUVER WA
98662-6314
US

IV. Provider business mailing address

11015 NE FOURTH PLAIN BLVD STE B
VANCOUVER WA
98662-6314
US

V. Phone/Fax

Practice location:
  • Phone: 360-892-0451
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5939
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH61048639
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: