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General NPI Number Information
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NPI Number | 1942422423
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Entity Type | Organization
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Legal Business Name | CORRECTIVE CHIROPRACTIC CARE, INC. PS
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 01/18/2008
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Provider Practice Location Address
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Address Line | 4444 LACEY BLVD SE STE E
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City | LACEY
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State | WA
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Zip | 98503
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Country | US
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Telephone | 360-438-1998
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Fax | 360-438-3524
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Provider Business Mailing Address
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Address Line | PO BOX 5859
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City | LACEY
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State | WA
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Zip | 98509
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Country | US
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Telephone | 360-438-1998
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Fax | 360-438-3524
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. HOWARD W FRIEDLY
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Credential | D.C.
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Telephone | 360-438-1998
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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 | CH00001743
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License Number State | WA
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