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NPI Code Detail

MEDICARE: SUMMIT CHIROPRACTIC LLC

MEDICARE: SUMMIT CHIROPRACTIC LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractorCH60219210WA

General Provider Information

NPI Number : 1619263555
Entity Type Code : Organization
Provider Name (Legal Business Name) : SUMMIT CHIROPRACTIC LLC
Provider Business Mailing Address
First Line : 831 12TH AVE
Second Line :
City : LONGVIEW
State : WA
Zip : 98632-2403
Country : US
Telephone Number : 360-575-9155
Fax Number : 360-636-5009
Provider Business Practice Location Address
First Line : 831 12TH AVE
Second Line :
City : LONGVIEW
State : WA
Zip : 98632-2403
Country : US
Telephone Number : 360-575-9155
Fax Number : 360-636-5009
Authorized Official
Title or Position : OWNER/CHIROPRACTOR
Name : DAVID CHARLES DALGARDNO
Credential : D.C.
Telephone Number : 360-575-9155
Provider Enumeration Date : 06/20/2011
Last Update Date : 06/27/2011

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Directions to “SUMMIT CHIROPRACTIC LLC ” Practice Location

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