Provider Demographics
NPI:1629214978
Name:SCODELLER CHIROPRACTIC, A PC
Entity Type:Organization
Organization Name:SCODELLER CHIROPRACTIC, A PC
Other - Org Name:BAKERVIEW FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:SCODELLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-734-7300
Mailing Address - Street 1:436 W BAKERVIEW RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-8177
Mailing Address - Country:US
Mailing Address - Phone:360-734-7300
Mailing Address - Fax:360-734-7301
Practice Address - Street 1:436 W BAKERVIEW RD
Practice Address - Street 2:SUITE 102
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-8177
Practice Address - Country:US
Practice Address - Phone:360-734-7300
Practice Address - Fax:360-734-7301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-16
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60023838111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty