=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578747622
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LEMBKE CHIROPRACTIC CLINIC PS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/26/2007
-----------------------------------------------------
Last Update Date | 02/23/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11015 NE FOURTH PLAIN RD SUITE B
-----------------------------------------------------
City | VANCOUVER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98662-6314
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-892-0451
-----------------------------------------------------
Fax | 360-892-1601
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11015 NE FOURTH PLAIN RD SUITE B
-----------------------------------------------------
City | VANCOUVER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98662-6314
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-892-0451
-----------------------------------------------------
Fax | 360-892-1601
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. SCOTT DAVID LEMBKE
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 360-892-0451
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 2025
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------