Provider Demographics
NPI:1346517570
Name:RIVERWOODS CHIROPRACTIC & MASSAGE, PLLC
Entity Type:Organization
Organization Name:RIVERWOODS CHIROPRACTIC & MASSAGE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:E
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-414-3220
Mailing Address - Street 1:820 OCEAN BEACH HWY
Mailing Address - Street 2:SUITE 116
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-4080
Mailing Address - Country:US
Mailing Address - Phone:360-414-3220
Mailing Address - Fax:360-353-5350
Practice Address - Street 1:820 OCEAN BEACH HWY
Practice Address - Street 2:SUITE 116
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-4080
Practice Address - Country:US
Practice Address - Phone:360-414-3220
Practice Address - Fax:360-353-5350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00033950111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB19254Medicare PIN
WAU83805Medicare UPIN