Healthcare Provider Details

I. General information

NPI: 1588252282
Provider Name (Legal Business Name): ATLAS SPINAL CARE VANCOUVER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2021
Last Update Date: 01/07/2021
Certification Date: 01/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16500 SE 15TH ST STE 160
VANCOUVER WA
98683-9666
US

IV. Provider business mailing address

16500 SE 15TH ST STE 160
VANCOUVER WA
98683-9666
US

V. Phone/Fax

Practice location:
  • Phone: 360-718-7944
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. NICOLE CZECH
Title or Position: PRESIDENT
Credential: DC
Phone: 360-718-7944