Provider Demographics
NPI:1093262842
Name:KLOBUTCHER, DOUGLASS MCROBERTS (DC)
Entity Type:Individual
Prefix:DR
First Name:DOUGLASS
Middle Name:MCROBERTS
Last Name:KLOBUTCHER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 SE 164TH AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-9297
Mailing Address - Country:US
Mailing Address - Phone:360-567-1205
Mailing Address - Fax:630-468-1478
Practice Address - Street 1:605 SE 164TH AVE STE 101
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-9297
Practice Address - Country:US
Practice Address - Phone:360-567-1205
Practice Address - Fax:630-468-1478
Is Sole Proprietor?:No
Enumeration Date:2016-09-08
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60683062111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor