=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669127916
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | OMAR ALEJANDRO FLORES DC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/15/2022
-----------------------------------------------------
Last Update Date | 02/15/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 221A NE 104TH AVE STE 205
-----------------------------------------------------
City | VANCOUVER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98664-4539
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-464-1900
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4801 E 5TH ST APT C309
-----------------------------------------------------
City | VANCOUVER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98661-6007
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-504-7349
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CH61246503
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------