Provider Demographics
NPI:1275671927
Name:THREE RIVERS LTD.
Entity Type:Organization
Organization Name:THREE RIVERS LTD.
Other - Org Name:DASSO CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:LEMIEUX
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:509-837-5022
Mailing Address - Street 1:PO BOX 779
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:WA
Mailing Address - Zip Code:98944-0779
Mailing Address - Country:US
Mailing Address - Phone:509-837-5022
Mailing Address - Fax:509-837-4501
Practice Address - Street 1:1301 E EDISON AVE
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:WA
Practice Address - Zip Code:98944-1620
Practice Address - Country:US
Practice Address - Phone:509-837-5022
Practice Address - Fax:509-837-4501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001360111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA46630OtherLABOR & INDUSTRIES
WA2070407Medicaid
WALE5811OtherREGENCE BLUE SHIELD
WAWA07234Medicare ID - Type UnspecifiedMEDICARE
WA2070407Medicaid