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General NPI Number Information
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NPI Number | 1700390267
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Entity Type | Organization
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Legal Business Name | ADVANCED WELLNESS & REHABILITATION PLLC
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Dates
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Enumeration Date | 11/20/2017
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Last Update Date | 11/20/2017
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Provider Practice Location Address
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Address Line | 10513 SILVERDALE WAY NW STE 102
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City | SILVERDALE
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State | WA
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Zip | 98383-9499
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Country | US
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Telephone | 360-698-4411
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Fax |
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Provider Business Mailing Address
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Address Line | 10513 SILVERDALE WAY NW STE 102
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City | SILVERDALE
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State | WA
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Zip | 98383-9499
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Country | US
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Telephone | 360-698-4411
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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 | DARLENE S TREBIBSKI
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Credential |
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Telephone | 360-698-4411
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC0005183762
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License Number State | WA
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