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General NPI Number Information
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NPI Number | 1619279197
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Entity Type | Organization
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Legal Business Name | VANCOUVER SPINAL CARE
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Dates
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Enumeration Date | 12/03/2010
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Last Update Date | 12/03/2010
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Provider Practice Location Address
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Address Line | 1610 C ST STE 103
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City | VANCOUVER
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State | WA
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Zip | 98663-3400
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Country | US
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Telephone | 360-694-0300
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Fax |
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Provider Business Mailing Address
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Address Line | 1610 C ST STE 103
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City | VANCOUVER
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State | WA
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Zip | 98663-3400
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Country | US
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Telephone | 360-694-0300
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | JENNIPHER HAU
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Credential |
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Telephone | 360-694-0300
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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 | CH00034415
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License Number State | WA
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