Organization
PROVASOLI CHIROPRACTIC INC.
Active
Other names
Provasoli Chiropractic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK DEN HARTOG DC (OWNER/CHIROPRACTOR)
(515) 822-0405
Entity
Organization
Contact information
Practice address
1018 7TH AVE SE, OLYMPIA, WA 98501-1512
(360) 459-8114
Mailing address
1018 7TH AVE SE, OLYMPIA, WA 98501-1512
(515) 822-0405
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
60741817
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1023081155
CHIROPRACTOR
WA
Enumeration date
02/01/2018
Last updated
02/01/2018
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