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General NPI Number Information
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NPI Number | 1841470432
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Entity Type | Organization
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Legal Business Name | WOODLAND CHIROPRACTIC WELLNESS CLINIC, PS
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Dates
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Enumeration Date | 11/12/2007
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Last Update Date | 11/30/2007
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Provider Practice Location Address
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Address Line | 1933 BELMONT LOOP STE C
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City | WOODLAND
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State | WA
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Zip | 98674-8492
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Country | US
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Telephone | 360-225-5726
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Fax | 360-225-2253
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Provider Business Mailing Address
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Address Line | PO BOX 1881
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City | WOODLAND
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State | WA
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Zip | 98674-1800
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Country | US
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Telephone | 360-225-5726
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Fax | 360-225-2253
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Authorized Official
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Title or Position | OWNER/CHIROPRACTOR
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Name | MR. JAY SCOTT DAWSON
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Credential | D.C. , CCN
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Telephone | 360-225-5726
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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 | CH00002773
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License Number State | WA
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