Provider Demographics
NPI:1114768066
Name:RIDGEFIELD CHIROPRACTIC LLC
Entity type:Organization
Organization Name:RIDGEFIELD CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:HAVALAH
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-468-1184
Mailing Address - Street 1:13203 NE 60TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-4949
Mailing Address - Country:US
Mailing Address - Phone:360-609-8042
Mailing Address - Fax:
Practice Address - Street 1:414 PIONEER ST
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:WA
Practice Address - Zip Code:98642-4512
Practice Address - Country:US
Practice Address - Phone:360-468-1184
Practice Address - Fax:360-887-2954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty