Provider Demographics
NPI:1609898063
Name:NORDSTROM, DOUGLAS ARTHUR (DC)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:ARTHUR
Last Name:NORDSTROM
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 1:5123 133RD PL NE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98271-7727
Mailing Address - Country:US
Mailing Address - Phone:360-653-6533
Mailing Address - Fax:360-653-7201
Practice Address - Street 1:1818 GROVE ST
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-4330
Practice Address - Country:US
Practice Address - Phone:360-653-6533
Practice Address - Fax:360-653-7201
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001060111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA14608OtherWORKER'S COMPENSATION
WA2007508Medicaid
WA2007508Medicaid
U24076Medicare UPIN