Provider Demographics
NPI:1790153138
Name:VANCOUVER WELLNESS CLINIC, LLC
Entity Type:Organization
Organization Name:VANCOUVER WELLNESS CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERICHA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARE
Authorized Official - Suffix:
Authorized Official - Credentials:ND, LAC
Authorized Official - Phone:360-882-4642
Mailing Address - Street 1:304 E 37TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663-2212
Mailing Address - Country:US
Mailing Address - Phone:360-882-4642
Mailing Address - Fax:360-892-6415
Practice Address - Street 1:304 E 37TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-2212
Practice Address - Country:US
Practice Address - Phone:360-882-4642
Practice Address - Fax:360-892-6415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-02
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT60545534261QH0100X
WAAC60545576261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service