Provider Demographics
NPI:1619067667
Name:ABSOLUTE LIFE CHIROPRACTIC INC PS
Entity Type:Organization
Organization Name:ABSOLUTE LIFE CHIROPRACTIC INC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:DREILING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-260-6903
Mailing Address - Street 1:9418 NE VANCOUVER MALL DR #105
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662
Mailing Address - Country:US
Mailing Address - Phone:360-260-6903
Mailing Address - Fax:
Practice Address - Street 1:3021 NE 72ND DR
Practice Address - Street 2:15
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661
Practice Address - Country:US
Practice Address - Phone:360-260-6903
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003052111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8892184Medicare PIN