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General NPI Number Information
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NPI Number | 1417148388
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Entity Type | Organization
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Legal Business Name | ZILLAH CHIROPRACTIC CENTER INC PS
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Dates
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Enumeration Date | 08/06/2007
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Last Update Date | 10/14/2010
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Provider Practice Location Address
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Address Line | 513 1ST AVE
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City | ZILLAH
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State | WA
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Zip | 98953
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Country | US
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Telephone | 509-829-6101
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Fax | 509-829-6101
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Provider Business Mailing Address
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Address Line | PO BOX 1841
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City | ZILLAH
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State | WA
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Zip | 98953-1841
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Country | US
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Telephone | 509-829-6101
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Fax | 509-829-6101
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Authorized Official
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Title or Position | CHIROPRACTOR OWNER
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Name | DR. SCOTT JAMES CARMACK
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Credential | DC
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Telephone | 509-829-6101
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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 | CH00034056
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License Number State | WA
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