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General NPI Number Information
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NPI Number | 1407207665
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Entity Type | Organization
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Legal Business Name | FIRESIDE CHIROPRACTIC, L.L.C.
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Dates
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Enumeration Date | 06/28/2016
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Last Update Date | 06/28/2016
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Provider Practice Location Address
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Address Line | 909 W MAIN ST
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City | BATTLE GROUND
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State | WA
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Zip | 98604-4884
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Country | US
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Telephone | 360-949-0936
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1122
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City | BATTLE GROUND
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State | WA
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Zip | 98604-1122
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KIRSTEN FRIBERG
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Credential | DC
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Telephone | 360-949-0936
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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 | CH60538356
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License Number State | WA
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