Provider Demographics
NPI:1912549403
Name:SANCHEZ, JORGE IVAN (CHIROPRACTOR)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:IVAN
Last Name:SANCHEZ
Suffix:
Gender:M
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2627 CAPITAL MALL DR SW # B3A
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-8696
Mailing Address - Country:US
Mailing Address - Phone:360-786-6322
Mailing Address - Fax:360-786-5677
Practice Address - Street 1:2627 CAPITAL MALL DR SW # B3A
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-8696
Practice Address - Country:US
Practice Address - Phone:360-786-6322
Practice Address - Fax:360-786-5677
Is Sole Proprietor?:No
Enumeration Date:2019-10-16
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60995032111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor