=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396245635
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RAYMOND CHIROPRACTIC INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2018
-----------------------------------------------------
Last Update Date | 02/13/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1702 S 72ND ST STE A
-----------------------------------------------------
City | TACOMA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98408-1238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-474-0677
-----------------------------------------------------
Fax | 253-474-3540
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1702 S 72ND ST STE A
-----------------------------------------------------
City | TACOMA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98408-1238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-474-0677
-----------------------------------------------------
Fax | 253-474-3540
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING ASSOCIATE
-----------------------------------------------------
Name | MS. VIRGINIA SELBY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 253-474-0677
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CH00002175
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------