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General NPI Number Information
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NPI Number | 1366616922
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Entity Type | Organization
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Legal Business Name | PROACTIVE CARE CHIROPRACTIC
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Dates
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Enumeration Date | 04/15/2008
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Last Update Date | 06/27/2014
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Provider Practice Location Address
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Address Line | 808 SE CHKALOV DR. SUITE 1
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City | VANCOUVER
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State | WA
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Zip | 86383
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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 | 808 SE CHKALOV DR. SUITE 1
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City | VANCOUVER
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State | WA
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Zip | 98683
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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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Authorized Official
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Title or Position | CHIROPRACTOR/OWNER
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Name | DR. JEFFREY RYAN SEALE
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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 | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | CH00034699
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License Number State | WA
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