=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497977243
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOHN V COFFEY D C INC P S
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/02/2007
-----------------------------------------------------
Last Update Date | 04/07/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4701 AUBURN WAY N
-----------------------------------------------------
City | AUBURN
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98002-1312
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-850-2225
-----------------------------------------------------
Fax | 253-850-5757
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4701 AUBURN WAY N
-----------------------------------------------------
City | AUBURN
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98002-1312
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-850-2225
-----------------------------------------------------
Fax | 253-850-5757
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JOHN V COFFEY
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 253-850-2225
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CH0001167
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------