Provider Demographics
NPI:1518312354
Name:BRIDGE CHIROPRACTIC 3 PLLC
Entity Type:Organization
Organization Name:BRIDGE CHIROPRACTIC 3 PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:A
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-574-5944
Mailing Address - Street 1:1227 N GOERIG ST
Mailing Address - Street 2:SUITE H
Mailing Address - City:WOODLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98674-9741
Mailing Address - Country:US
Mailing Address - Phone:360-225-1200
Mailing Address - Fax:360-225-1266
Practice Address - Street 1:1227 N GOERIG ST
Practice Address - Street 2:SUITE H
Practice Address - City:WOODLAND
Practice Address - State:WA
Practice Address - Zip Code:98674-9741
Practice Address - Country:US
Practice Address - Phone:360-225-1200
Practice Address - Fax:360-225-1266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-29
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003537111N00000X
WACH60610892111N00000X
WAMA00020049225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty