=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831206911
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMMUNITY CHIROPRACTIC PS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/24/2006
-----------------------------------------------------
Last Update Date | 04/25/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2968 LIMITED LANE NW SUITE A
-----------------------------------------------------
City | OLYMPIA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-705-1116
-----------------------------------------------------
Fax | 360-236-0535
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3525 ENSIGN RD NE STE G
-----------------------------------------------------
City | OLYMPIA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98506-5065
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-705-1116
-----------------------------------------------------
Fax | 360-236-0535
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. GWENDOLYN MARIE SCHAUER
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 360-705-1116
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 2556
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------