Provider Demographics
NPI:1619279197
Name:VANCOUVER SPINAL CARE
Entity Type:Organization
Organization Name:VANCOUVER SPINAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:HAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-694-0300
Mailing Address - Street 1:1610 C ST STE 103
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663-3400
Mailing Address - Country:US
Mailing Address - Phone:360-694-0300
Mailing Address - Fax:
Practice Address - Street 1:1610 C ST STE 103
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-3400
Practice Address - Country:US
Practice Address - Phone:360-694-0300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-03
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034415261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service