Provider Demographics
NPI:1205837929
Name:DORNBUSCH, MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:DORNBUSCH
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 1:3307 EVERGREEN WAY
Mailing Address - Street 2:SUITE 601
Mailing Address - City:WASHOUGAL
Mailing Address - State:WA
Mailing Address - Zip Code:98671-2062
Mailing Address - Country:US
Mailing Address - Phone:360-835-9981
Mailing Address - Fax:360-835-5765
Practice Address - Street 1:3307 EVERGREEN WAY
Practice Address - Street 2:SUITE 601
Practice Address - City:WASHOUGAL
Practice Address - State:WA
Practice Address - Zip Code:98671-2062
Practice Address - Country:US
Practice Address - Phone:360-835-9981
Practice Address - Fax:360-835-5765
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034607111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor