Healthcare Provider Details

I. General information

NPI: 1336594589
Provider Name (Legal Business Name): BRIDGE CHIROPRACTIC 2 PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2016
Last Update Date: 04/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 SE 164TH AVE SUITE 101
VANCOUVER WA
98684-9297
US

IV. Provider business mailing address

605 SE 164TH AVE SUITE 101
VANCOUVER WA
98684-9297
US

V. Phone/Fax

Practice location:
  • Phone: 360-567-1205
  • Fax: 360-567-1206
Mailing address:
  • Phone: 360-567-1205
  • Fax: 360-567-1206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00015207
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH00003537
License Number StateWA

VIII. Authorized Official

Name: PAUL A. REED
Title or Position: OWNER/CHIROPRACTOR
Credential: DC
Phone: 360-574-5944