Healthcare Provider Details

I. General information

NPI: 1760544019
Provider Name (Legal Business Name): GOOD HEALTH NATURALLY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3606 MAIN ST STE 205
VANCOUVER WA
98663-2257
US

IV. Provider business mailing address

3606 MAIN ST SUITE 205
VANCOUVER WA
98663-2257
US

V. Phone/Fax

Practice location:
  • Phone: 360-693-7781
  • Fax: 360-693-1688
Mailing address:
  • Phone: 360-693-7781
  • Fax: 360-693-1688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH00003457
License Number StateWA

VIII. Authorized Official

Name: DR. MARK J BLESSLEY
Title or Position: OWNER
Credential: DC
Phone: 360-693-7781