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General NPI Number Information
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NPI Number | 1902477722
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Entity Type | Organization
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Legal Business Name | FORTIFY FAMILY CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 07/02/2021
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Last Update Date | 02/05/2022
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Provider Practice Location Address
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Address Line | 4525 ROAD 68 STE H
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City | PASCO
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State | WA
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Zip | 99301-9595
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Country | US
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Telephone | 509-737-9355
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Fax |
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Provider Business Mailing Address
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Address Line | 7403 W ARROWHEAD AVE STE 120
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City | KENNEWICK
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State | WA
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Zip | 99336-1122
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Country | US
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Telephone | 509-989-5844
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Fax |
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Authorized Official
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Title or Position | MGR
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Name | JAMES DANE RINER
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Credential | D.C.
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Telephone | 509-558-8090
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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 |
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License Number State |
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