Provider Demographics
NPI:1972884302
Name:THE SPA AT PACIFIC WELLNESS, LLC
Entity Type:Organization
Organization Name:THE SPA AT PACIFIC WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:CORLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:253-564-8100
Mailing Address - Street 1:4114 BRIDGEPORT WAY W
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-4303
Mailing Address - Country:US
Mailing Address - Phone:253-564-4508
Mailing Address - Fax:253-564-8387
Practice Address - Street 1:4114 BRIDGEPORT WAY W
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-4303
Practice Address - Country:US
Practice Address - Phone:253-564-4508
Practice Address - Fax:253-564-8387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty