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General NPI Number Information
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NPI Number | 1902262835
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Entity Type | Organization
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Legal Business Name | CASCADIA CLINIC LLC
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Dates
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Enumeration Date | 01/07/2016
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Last Update Date | 01/07/2016
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Provider Practice Location Address
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Address Line | 1507 172ND ST NE SUITE A
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City | MARYSVILLE
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State | WA
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Zip | 98271-5484
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Country | US
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Telephone | 360-652-7246
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Fax | 360-654-0611
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Provider Business Mailing Address
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Address Line | 1507 172ND ST NE SUITE A
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City | MARYSVILLE
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State | WA
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Zip | 98271-5484
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Country | US
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Telephone | 360-652-7246
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Fax | 360-654-0611
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Authorized Official
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Title or Position | OWNER/DOCTOR OF CHIROPRACTIC
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Name | DR. MICHAEL T BRENEMAN
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Credential | D.C.
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Telephone | 360-652-7246
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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 | CH60402217
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA00021076
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 247200000X
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Taxonomy Name | Other Technician
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License Number | CX60618136
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License Number State | WA
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Taxonomy #4
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH00001293
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License Number State | WA
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