Provider Demographics
NPI:1922291772
Name:CROFTS INC
Entity Type:Organization
Organization Name:CROFTS INC
Other - Org Name:QUALITY CHIROPRACTIC PAIN RELIEF CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:DC
Authorized Official - Prefix:
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:E
Authorized Official - Last Name:CROFTS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-256-0200
Mailing Address - Street 1:14602 NE 4TH PLAIN
Mailing Address - Street 2:STE K
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682
Mailing Address - Country:US
Mailing Address - Phone:360-256-0200
Mailing Address - Fax:360-256-0300
Practice Address - Street 1:14602 NE 4TH PLAIN
Practice Address - Street 2:STE K
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98682
Practice Address - Country:US
Practice Address - Phone:360-256-0200
Practice Address - Fax:360-256-0300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00033808111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8806557OtherINDIVIDUAL
WA8806557OtherINDIVIDUAL