Provider Demographics
NPI:1750827044
Name:EVERGREEN CHIROPRACTIC & HEALTH, LLC
Entity Type:Organization
Organization Name:EVERGREEN CHIROPRACTIC & HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUCAS
Authorized Official - Middle Name:D
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:509-551-5365
Mailing Address - Street 1:604 WILLIAMS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99354-3207
Mailing Address - Country:US
Mailing Address - Phone:509-551-5365
Mailing Address - Fax:
Practice Address - Street 1:604 WILLIAMS BLVD STE A
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99354-3207
Practice Address - Country:US
Practice Address - Phone:509-551-5365
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-11
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60697756111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty