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General NPI Number Information
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NPI Number | 1811317548
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Entity Type | Organization
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Legal Business Name | FAMILY CHIROPRACTIC CARE BACK PAIN CLINIC PC
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Dates
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Enumeration Date | 04/21/2014
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Last Update Date | 04/21/2014
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Provider Practice Location Address
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Address Line | 1815 HUDSON STREET
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City | LONGVIEW
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State | WA
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Zip | 98632
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Country | US
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Telephone | 360-636-2636
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Fax | 360-636-2621
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Provider Business Mailing Address
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Address Line | 1815 HUDSON STREET
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City | LONGVIEW
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State | WA
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Zip | 98632
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Country | US
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Telephone | 360-636-2636
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Fax | 360-636-2621
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Authorized Official
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Title or Position | OWNER
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Name | RICK D STILL
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Credential | D.C.
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Telephone | 360-636-2636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | CH00001766
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License Number State | WA
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