Healthcare Provider Details

I. General information

NPI: 1285918318
Provider Name (Legal Business Name): PUARIEA CHIROPRACTIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2011
Last Update Date: 10/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2417 E EVERGREEN BLVD
VANCOUVER WA
98661-4320
US

IV. Provider business mailing address

2417 E EVERGREEN BLVD
VANCOUVER WA
98661-4320
US

V. Phone/Fax

Practice location:
  • Phone: 360-694-3021
  • Fax: 360-694-5187
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberCH00000730
License Number StateWA

VIII. Authorized Official

Name: DR. ELVERINE ELZBETH PUARIEA
Title or Position: OWNER
Credential: D.C.
Phone: 360-694-3021