Provider Demographics
NPI:1356684633
Name:VISION QUEST CHIROPRACTIC AND WELLNESS
Entity Type:Organization
Organization Name:VISION QUEST CHIROPRACTIC AND WELLNESS
Other - Org Name:LIFE FORCE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GEMMER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-308-0250
Mailing Address - Street 1:9414 RIDGETOP BLVD NW
Mailing Address - Street 2:101
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-8525
Mailing Address - Country:US
Mailing Address - Phone:360-308-0250
Mailing Address - Fax:360-308-0195
Practice Address - Street 1:1118 SUPERMALL WAY
Practice Address - Street 2:101
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98001-6569
Practice Address - Country:US
Practice Address - Phone:253-269-0261
Practice Address - Fax:253-269-0202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-04
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60089456111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty