Provider Demographics
NPI:1093099954
Name:VISION QUEST CHIROPRACTIC PUYALLUP INC
Entity Type:Organization
Organization Name:VISION QUEST CHIROPRACTIC PUYALLUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERWIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:GEMMER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-692-7321
Mailing Address - Street 1:9414 RIDGETOP BLVD NW
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-8526
Mailing Address - Country:US
Mailing Address - Phone:360-308-0250
Mailing Address - Fax:360-308-0195
Practice Address - Street 1:13333 MERIDIAN E
Practice Address - Street 2:STE H
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-2405
Practice Address - Country:US
Practice Address - Phone:253-200-4401
Practice Address - Fax:253-200-4402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-10
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00000909111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty