Healthcare Provider Details

I. General information

NPI: 1780447334
Provider Name (Legal Business Name): SALMON CREEK CHIROPRACTIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2024
Last Update Date: 02/05/2024
Certification Date: 02/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 NE 134TH ST STE 300
VANCOUVER WA
98686-3030
US

IV. Provider business mailing address

2501 NE 134TH ST STE 300
VANCOUVER WA
98686-3030
US

V. Phone/Fax

Practice location:
  • Phone: 360-975-1213
  • Fax:
Mailing address:
  • Phone: 360-975-1213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. ALVIN BLACK
Title or Position: CLINIC DIRECTOR
Credential:
Phone: 360-975-1213