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General NPI Number Information
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NPI Number | 1275874018
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Entity Type | Organization
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Legal Business Name | RJCIV, INC. P.S.
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Dates
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Enumeration Date | 03/04/2013
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Last Update Date | 03/04/2013
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Provider Practice Location Address
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Address Line | 1519 9TH ST SUITE 101
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City | MARYSVILLE
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State | WA
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Zip | 98270-4600
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Country | US
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Telephone | 360-658-1987
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Fax | 360-658-5618
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Provider Business Mailing Address
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Address Line | 1519 9TH ST SUITE 101
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City | MARYSVILLE
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State | WA
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Zip | 98270-4600
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Country | US
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Telephone | 360-658-1987
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Fax | 360-658-5618
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERT CLARKE
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Credential | D.C.
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Telephone | 360-658-1987
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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 | CH60145579
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License Number State | WA
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