Provider Demographics
NPI:1003449844
Name:ONE STOP MOBILE CHIROPRACTIC
Entity Type:Organization
Organization Name:ONE STOP MOBILE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAMONE
Authorized Official - Middle Name:DONNELL
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-989-8859
Mailing Address - Street 1:8101 83RD AVE SW APT D28
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98498-6016
Mailing Address - Country:US
Mailing Address - Phone:360-989-8859
Mailing Address - Fax:253-276-0118
Practice Address - Street 1:8101 83RD AVE SW APT D28
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98498-6016
Practice Address - Country:US
Practice Address - Phone:360-989-8859
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-20
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA604212913OtherBUSINESS LICENSE