Provider Demographics
NPI:1134289218
Name:ERNST, DAMON JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:DAMON
Middle Name:JOSEPH
Last Name:ERNST
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:PO BOX 2176
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98584
Mailing Address - Country:US
Mailing Address - Phone:360-426-8060
Mailing Address - Fax:360-427-5819
Practice Address - Street 1:1635 OLYMPIC HWY N
Practice Address - Street 2:STE 100
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:98584
Practice Address - Country:US
Practice Address - Phone:360-426-8060
Practice Address - Fax:360-427-5819
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003317111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2022044Medicaid
WA124581OtherLABOR & INDUSTRIES
WA8857857Medicare ID - Type Unspecified
WA2022044Medicaid