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General NPI Number Information
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NPI Number | 1407052350
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Entity Type | Organization
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Legal Business Name | FAMILY CHIROPRACTIC AT SALMON CREEK INC
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Dates
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Enumeration Date | 06/26/2007
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Last Update Date | 10/18/2007
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Provider Practice Location Address
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Address Line | 11815 NE HIGHWAY 99 STE A
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City | VANCOUVER
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State | WA
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Zip | 98686-4008
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Country | US
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Telephone | 360-696-4405
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Fax | 360-696-0582
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Provider Business Mailing Address
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Address Line | 11815 NE HIGHWAY 99 STE A
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City | VANCOUVER
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State | WA
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Zip | 98686-4008
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Country | US
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Telephone | 360-696-4405
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Fax | 360-696-0582
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. HARLEY O. YOUNGBLOOD III
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Credential | R.N. ,D.C.,F.I.C.P.A
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Telephone | 360-696-4405
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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 | CH00003002
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License Number State | WA
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