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General NPI Number Information
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NPI Number | 1932396785
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Entity Type | Organization
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Legal Business Name | BONNEY LAKE CHIROPRACTIC INC, PS
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Dates
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Enumeration Date | 09/25/2007
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Last Update Date | 03/08/2013
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Provider Practice Location Address
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Address Line | 9925 214TH AVE E SUITE C
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City | BONNEY LAKE
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State | WA
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Zip | 98391-3910
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Country | US
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Telephone | 253-862-6662
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Fax | 253-862-5553
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Provider Business Mailing Address
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Address Line | 9925 214TH AVE E SUITE C
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City | BONNEY LAKE
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State | WA
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Zip | 98391-3910
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Country | US
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Telephone | 253-862-6662
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Fax | 253-862-5553
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. SCOTT ALLAN SHERIDAN
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Credential | DC
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Telephone | 253-862-6662
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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 | CH00034053
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License Number State | WA
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