Provider Demographics
NPI:1346269727
Name:BRASWELL, ROBERT E, (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:E,
Last Name:BRASWELL
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 873546
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98687-3546
Mailing Address - Country:US
Mailing Address - Phone:360-253-9482
Mailing Address - Fax:360-253-5366
Practice Address - Street 1:916 SE 164TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-9602
Practice Address - Country:US
Practice Address - Phone:360-253-9482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002801111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0133632OtherL&I
WA602-009-365OtherUBI
WA912012316OtherTAX ID
WA912012316OtherTAX ID
WAGAB14825Medicare ID - Type UnspecifiedMEDICARE