Healthcare Provider Details

I. General information

NPI: 1588396907
Provider Name (Legal Business Name): PAIGE KAVANAGH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2022
Last Update Date: 06/24/2022
Certification Date: 06/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7317 E MILL PLAIN BLVD
VANCOUVER WA
98664-1300
US

IV. Provider business mailing address

PO BOX 74008519 PMB 1552
CHICAGO IL
60674-0001
US

V. Phone/Fax

Practice location:
  • Phone: 360-695-4041
  • Fax: 360-693-2490
Mailing address:
  • Phone: 360-695-4041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH61281384
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: