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General NPI Number Information
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NPI Number | 1386216745
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Entity Type | Organization
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Legal Business Name | CANYON CHIROPRACTIC
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Dates
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Enumeration Date | 07/14/2021
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Last Update Date | 07/14/2021
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Provider Practice Location Address
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Address Line | 5216 72ND ST E
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City | TACOMA
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State | WA
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Zip | 98443-2722
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Country | US
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Telephone | 253-537-8181
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Fax | 253-537-8181
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Provider Business Mailing Address
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Address Line | PO BOX 146
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City | PUYALLUP
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State | WA
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Zip | 98371-0015
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Country | US
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Telephone | 253-537-8181
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Fax | 253-537-8181
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Authorized Official
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Title or Position | OWNER/CHIROPRACTOR
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Name | TERRY RICHARDSON
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Credential | DC
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Telephone | 253-537-8181
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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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