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General NPI Number Information
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NPI Number | 1730676545
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Entity Type | Organization
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Legal Business Name | BRIE CHANI HENDERSON
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Dates
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Enumeration Date | 04/17/2018
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Last Update Date | 04/17/2018
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Provider Practice Location Address
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Address Line | 5514 NE 107TH AVE STE 101
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City | VANCOUVER
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State | WA
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Zip | 98662-6346
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Country | US
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Telephone | 360-254-0400
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Fax | 360-254-9022
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Provider Business Mailing Address
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Address Line | 5514 NE 107TH AVE STE 101
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City | VANCOUVER
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State | WA
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Zip | 98662-6346
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Country | US
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Telephone | 360-254-0400
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Fax | 360-254-9022
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Authorized Official
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Title or Position | CLINIC OWNER
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Name | DR. BRIE CHANI HENDERSON
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Credential | DC
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Telephone | 360-254-0400
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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 | CH60200517
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License Number State | WA
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