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General NPI Number Information
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NPI Number | 1114768066
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Entity Type | Organization
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Legal Business Name | RIDGEFIELD CHIROPRACTIC LLC
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Dates
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Enumeration Date | 06/04/2024
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Last Update Date | 06/04/2024
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Provider Practice Location Address
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Address Line | 414 PIONEER ST
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City | RIDGEFIELD
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State | WA
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Zip | 98642-4512
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Country | US
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Telephone | 360-468-1184
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Fax | 360-887-2954
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Provider Business Mailing Address
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Address Line | 13203 NE 60TH AVE
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City | VANCOUVER
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State | WA
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Zip | 98686-4949
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Country | US
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Telephone | 360-609-8042
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | HAVALAH CARLSON
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Credential | DC
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Telephone | 360-468-1184
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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