Healthcare Provider Details

I. General information

NPI: 1235209479
Provider Name (Legal Business Name): DECAMP-LEWIS CHIROPRACTIC CLINIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 05/17/2022
Certification Date: 05/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 N MISSION ST STE 102
WENATCHEE WA
98801-2065
US

IV. Provider business mailing address

610 N MISSION ST STE 102
WENATCHEE WA
98801-2065
US

V. Phone/Fax

Practice location:
  • Phone: 509-662-4711
  • Fax: 509-662-2800
Mailing address:
  • Phone: 509-662-4711
  • Fax: 509-662-2800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH00001059
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA00020262
License Number StateWA

VIII. Authorized Official

Name: MRS. MAUREEN RENEE DEXTER
Title or Position: OFFICE MANAGER
Credential:
Phone: 509-662-4711