Organization
A FAMILY & SPORTS CHIROPRACTIC CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHERYLLE RAMOS (OFFICE MANAGER)
(360) 254-0400
Entity
Organization
Contact information
Practice address
5514 NE 107TH AVE STE 101, VANCOUVER, WA 98662-6346
(360) 254-0400
Mailing address
5514 NE 107TH AVE STE 101, VANCOUVER, WA 98662-6346
(360) 254-0400
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2337
WA
111N00000X
Chiropractor
CH60200517
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G000615536
MEDICARE PTAN
WA
01
—
G8899092
MEDICARE PTAN
WA
Enumeration date
09/14/2015
Last updated
09/22/2015
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