Provider Demographics
NPI:1891059598
Name:SKAMANIA CHIROPRACTIC AND REHABILITATION PLLC
Entity type:Organization
Organization Name:SKAMANIA CHIROPRACTIC AND REHABILITATION PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MITZI
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:FERRILL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:509-427-3600
Mailing Address - Street 1:PO BOX 1498
Mailing Address - Street 2:
Mailing Address - City:STEVENSON
Mailing Address - State:WA
Mailing Address - Zip Code:98648-1498
Mailing Address - Country:US
Mailing Address - Phone:509-427-3600
Mailing Address - Fax:
Practice Address - Street 1:138 NW 2ND ST
Practice Address - Street 2:
Practice Address - City:STEVENSON
Practice Address - State:WA
Practice Address - Zip Code:98648-4225
Practice Address - Country:US
Practice Address - Phone:509-427-3600
Practice Address - Fax:509-427-3601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-27
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60264407111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1891059598OtherNPI