Provider Demographics
NPI:1235209479
Name:DECAMP-LEWIS CHIROPRACTIC CLINIC, PLLC
Entity Type:Organization
Organization Name:DECAMP-LEWIS CHIROPRACTIC CLINIC, PLLC
Other - Org Name:MULLEN-DECAMP-TOFTNESS CHIROPRACTIC CLINIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:DEXTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-662-4711
Mailing Address - Street 1:610 N MISSION ST STE 102
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-2065
Mailing Address - Country:US
Mailing Address - Phone:509-662-4711
Mailing Address - Fax:509-662-2800
Practice Address - Street 1:610 N MISSION ST STE 102
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-2065
Practice Address - Country:US
Practice Address - Phone:509-662-4711
Practice Address - Fax:509-662-2800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001059111N00000X
WAMA00020262174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA115101000Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
WADA5434Medicare ID - Type UnspecifiedRAILROAD MEDICARE GROUP #