Provider Demographics
NPI:1750497236
Name:ADVANTAGE CHIROPRATIC & MASSAGE, P.S.
Entity Type:Organization
Organization Name:ADVANTAGE CHIROPRATIC & MASSAGE, P.S.
Other - Org Name:BRAYER CHIROPRACTIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DARIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SHOOK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-425-6620
Mailing Address - Street 1:1424 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-2901
Mailing Address - Country:US
Mailing Address - Phone:360-425-6620
Mailing Address - Fax:360-425-1277
Practice Address - Street 1:1424 16TH AVE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2901
Practice Address - Country:US
Practice Address - Phone:360-425-6620
Practice Address - Fax:360-425-1277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB25383Medicare PIN