Healthcare Provider Details

I. General information

NPI: 1518312354
Provider Name (Legal Business Name): BRIDGE CHIROPRACTIC 3 PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2016
Last Update Date: 04/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1227 N GOERIG ST SUITE H
WOODLAND WA
98674-9741
US

IV. Provider business mailing address

1227 N GOERIG ST SUITE H
WOODLAND WA
98674-9741
US

V. Phone/Fax

Practice location:
  • Phone: 360-225-1200
  • Fax: 360-225-1266
Mailing address:
  • Phone: 360-225-1200
  • Fax: 360-225-1266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH60610892
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00020049
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH00003537
License Number StateWA

VIII. Authorized Official

Name: PAUL A. REED
Title or Position: OWNER/CHIROPRACTOR
Credential: DC
Phone: 360-574-5944