Healthcare Provider Details

I. General information

NPI: 1437390747
Provider Name (Legal Business Name): MICHAEL A. DORNBUSCH, DC, PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2009
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3307 EVERGREEN WAY SUITE 601
WASHOUGAL WA
98671-2062
US

IV. Provider business mailing address

3307 EVERGREEN WAY STE 603
WASHOUGAL WA
98671-2062
US

V. Phone/Fax

Practice location:
  • Phone: 360-835-9911
  • Fax:
Mailing address:
  • Phone: 360-835-7601
  • Fax: 360-210-5646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. MICHAEL A DORNBUSCH
Title or Position: PRESIDENT/CHIROPRACTOR
Credential: DC
Phone: 360-772-9981