Healthcare Provider Details

I. General information

NPI: 1447640347
Provider Name (Legal Business Name): VANCOUVER CHIROPRACTIC GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2015
Last Update Date: 01/29/2015
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

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

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DANIEL SCHNEIDER
Title or Position: OWNER
Credential: DC
Phone: 925-719-7510