Provider Demographics
NPI:1386406064
Name:VASHON CHIROPRACTIC, PS
Entity type:Organization
Organization Name:VASHON CHIROPRACTIC, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CORENE
Authorized Official - Middle Name:
Authorized Official - Last Name:BODILY-GOODMANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:253-347-0102
Mailing Address - Street 1:PO BOX 2421
Mailing Address - Street 2:
Mailing Address - City:VASHON
Mailing Address - State:WA
Mailing Address - Zip Code:98070-2421
Mailing Address - Country:US
Mailing Address - Phone:206-259-0216
Mailing Address - Fax:
Practice Address - Street 1:17147 VASHON HWY SW STE 111
Practice Address - Street 2:
Practice Address - City:VASHON
Practice Address - State:WA
Practice Address - Zip Code:98070-4603
Practice Address - Country:US
Practice Address - Phone:206-259-0216
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty