Provider Demographics
NPI:1730676545
Name:BRIE CHANI HENDERSON
Entity Type:Organization
Organization Name:BRIE CHANI HENDERSON
Other - Org Name:FAMILY & SPORTS CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIE
Authorized Official - Middle Name:CHANI
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-254-0400
Mailing Address - Street 1:5514 NE 107TH AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-6346
Mailing Address - Country:US
Mailing Address - Phone:360-254-0400
Mailing Address - Fax:360-254-9022
Practice Address - Street 1:5514 NE 107TH AVE STE 101
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-6346
Practice Address - Country:US
Practice Address - Phone:360-254-0400
Practice Address - Fax:360-254-9022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60200517111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty