Healthcare Provider Details

I. General information

NPI: 1700069135
Provider Name (Legal Business Name): QUICK RECOVERY CLINIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2007
Last Update Date: 12/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3303 NE MINNEHAHA ST SUITE C
VANCOUVER WA
98663-1499
US

IV. Provider business mailing address

PO BOX 65055
VANCOUVER WA
98665-0002
US

V. Phone/Fax

Practice location:
  • Phone: 360-750-0250
  • Fax: 360-750-0253
Mailing address:
  • Phone: 360-750-0250
  • Fax: 360-750-0253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number273264
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberCH00034005
License Number StateWA

VIII. Authorized Official

Name: DR. MICHELE MARIE NEWCOMER
Title or Position: OWNER
Credential: DC
Phone: 360-750-0250