Provider Demographics
NPI:1285266080
Name:E GROUP WA LLC
Entity type:Organization
Organization Name:E GROUP WA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:
Authorized Official - Last Name:LEAVITT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-892-1601
Mailing Address - Street 1:11015 NE FOURTH PLAIN BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-6314
Mailing Address - Country:US
Mailing Address - Phone:360-892-0451
Mailing Address - Fax:360-892-1601
Practice Address - Street 1:11015 NE FOURTH PLAIN BLVD STE B
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-6314
Practice Address - Country:US
Practice Address - Phone:360-892-0451
Practice Address - Fax:360-892-1601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-10
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty