=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316044407
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID B BRIDGEMAN DC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2006
-----------------------------------------------------
Last Update Date | 05/19/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2211 W DOLARWAY RD STE 4
-----------------------------------------------------
City | ELLENSBURG
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98926-8227
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-925-7246
-----------------------------------------------------
Fax | 509-933-4104
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2211 W DOLARWAY RD STE 4
-----------------------------------------------------
City | ELLENSBURG
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98926-8227
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-925-7246
-----------------------------------------------------
Fax | 509-933-4104
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CH00034315
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------