Provider Demographics
NPI:1679605794
Name:DETWILER, ELIZABETH JOAN (DC)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:JOAN
Last Name:DETWILER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17720 SE MILL PLAIN BLVD STE 160
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-7585
Mailing Address - Country:US
Mailing Address - Phone:360-944-4437
Mailing Address - Fax:360-944-4437
Practice Address - Street 1:17720 SE MILL PLAIN BLVD STE 160
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-7585
Practice Address - Country:US
Practice Address - Phone:360-944-4437
Practice Address - Fax:360-944-3925
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034738111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor