Healthcare Provider Details

I. General information

NPI: 1073081329
Provider Name (Legal Business Name): BRIDGE CHIROPRACTIC 1 PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2018
Last Update Date: 05/13/2020
Certification Date: 05/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13800 NE 20TH AVE
VANCOUVER WA
98686-2704
US

IV. Provider business mailing address

13800 NE 20TH AVE
VANCOUVER WA
98686-2704
US

V. Phone/Fax

Practice location:
  • Phone: 360-574-5944
  • Fax: 360-574-6430
Mailing address:
  • Phone: 360-574-5944
  • Fax: 360-574-6430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: PAUL REED
Title or Position: DC
Credential:
Phone: 360-574-5944