Provider Demographics
NPI:1396025870
Name:MAPLE VALLEY CHIROPRACTIC AND MASSAGE, INC.
Entity Type:Organization
Organization Name:MAPLE VALLEY CHIROPRACTIC AND MASSAGE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DONOVAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-789-0872
Mailing Address - Street 1:23220 MAPLE VALLEY BLACK DIAMOND RD SE
Mailing Address - Street 2:SUITE 13
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-5225
Mailing Address - Country:US
Mailing Address - Phone:425-432-1449
Mailing Address - Fax:425-432-9910
Practice Address - Street 1:23220 MAPLE VALLEY BLACK DIAMOND RD SE
Practice Address - Street 2:SUITE 13
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-5225
Practice Address - Country:US
Practice Address - Phone:425-432-1449
Practice Address - Fax:425-432-9910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-28
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034707111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty