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General NPI Number Information
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NPI Number | 1982124046
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Entity Type | Organization
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Legal Business Name | MILL CREEK SPINE AND INJURY, INC., P.S.
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Dates
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Enumeration Date | 06/21/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1112 76TH AVE NE
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City | LAKE STEVENS
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State | WA
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Zip | 98258-3201
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Country | US
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Telephone | 425-344-6835
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Fax |
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Provider Business Mailing Address
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Address Line | 1112 76TH AVE NE
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City | LAKE STEVENS
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State | WA
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Zip | 98258-3201
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Country | US
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Telephone | 425-344-6835
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RYAN L DOERGE
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Credential | DC
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Telephone | 425-280-9980
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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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