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General NPI Number Information
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NPI Number | 1659795540
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Entity Type | Organization
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Legal Business Name | 4DUCKLINGS INC.
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Dates
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Enumeration Date | 02/12/2014
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Last Update Date | 02/12/2014
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Provider Practice Location Address
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Address Line | 6403 NE 117TH AVE SUITE 109
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City | VANCOUVER
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State | WA
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Zip | 98662
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Country | US
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Telephone | 360-609-1557
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Fax |
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Provider Business Mailing Address
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Address Line | 6403 NE 117TH AVE SUITE 109
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City | VANCOUVER
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State | WA
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Zip | 98662-5560
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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 | CEO
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Name | DR. BLAKE E. CROFTS
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Credential | D.C.
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Telephone | 136-025-0200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 00033808
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License Number State | WA
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