=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407178080
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DONNA MARIA ARCHER, DC, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/23/2010
-----------------------------------------------------
Last Update Date | 02/23/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5512 NE 109TH CT SUITE A
-----------------------------------------------------
City | VANCOUVER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98662-6175
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-885-4715
-----------------------------------------------------
Fax | 360-859-3741
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5512 NE 109TH CT. SUITE A
-----------------------------------------------------
City | VANCOUVER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98662-6175
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-885-4715
-----------------------------------------------------
Fax | 360-859-3741
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. DONNA MARIA ARCHER
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 360-885-4715
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | MA60133357
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | MA60127460
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CH00033998
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------