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General NPI Number Information
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NPI Number | 1497270151
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Entity Type | Organization
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Legal Business Name | 180 BODYWORKS LLC
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Dates
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Enumeration Date | 08/03/2017
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Last Update Date | 08/03/2017
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Provider Practice Location Address
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Address Line | 4001 MAIN ST STE 216
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City | VANCOUVER
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State | WA
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Zip | 98663-1888
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Country | US
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Telephone | 360-609-8343
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Fax |
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Provider Business Mailing Address
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Address Line | 2504 34TH ST
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City | WASHOUGAL
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State | WA
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Zip | 98671-9157
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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 | MRS. ASHLEY ANNE MERKLIN
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Credential | LMP
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Telephone | 360-609-8343
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | MA60288718
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License Number State | WA
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