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General NPI Number Information
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NPI Number | 1255694428
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Entity Type | Organization
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Legal Business Name | DOZARK HEALTH AND WELLNESS INC
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Dates
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Enumeration Date | 06/21/2012
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Last Update Date | 06/21/2012
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Provider Practice Location Address
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Address Line | 11818 SE MILL PLAIN BLVD SUITE 408
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City | VANCOUVER
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State | WA
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Zip | 98684-5089
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Country | US
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Telephone | 360-254-0616
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Fax | 360-254-0618
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Provider Business Mailing Address
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Address Line | 513 SE 10TH ST
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City | BATTLE GROUND
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State | WA
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Zip | 98604-8998
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Country | US
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Telephone |
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Fax | 360-254-0618
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. JASON DOZARK
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Credential | DC
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Telephone | 360-254-0616
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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 | CH34345
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License Number State | WA
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