Healthcare Provider Details

I. General information

NPI: 1275983355
Provider Name (Legal Business Name): NORTHWEST PAIN RELIEF CENTERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2016
Last Update Date: 06/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16821 SE MCGILLIVRAY BLVD SUITE 204
VANCOUVER WA
98683-0499
US

IV. Provider business mailing address

PO BOX 1190
SILVERDALE WA
98383-1190
US

V. Phone/Fax

Practice location:
  • Phone: 360-433-9580
  • Fax: 866-824-5107
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KYLE BERGQUIST
Title or Position: OWNER
Credential: DC
Phone: 206-713-4721