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General NPI Number Information
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NPI Number | 1962852038
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Entity Type | Organization
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Legal Business Name | NORTHWEST PAIN RELIEF CENTERS, LLC
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Dates
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Enumeration Date | 06/20/2016
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Last Update Date | 08/11/2016
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Provider Practice Location Address
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Address Line | 503 W FIR ST SUITE D
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City | SEQUIM
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State | WA
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Zip | 98382-3210
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Country | US
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Telephone | 360-797-1728
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Fax | 360-797-1738
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Provider Business Mailing Address
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Address Line | PO BOX 1190
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City | SILVERDALE
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State | WA
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Zip | 98383-1190
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KYLE BERGQUIST
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Credential | DC
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Telephone | 206-713-4721
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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