Provider Demographics
NPI:1982854592
Name:EAST VANCOUVER CHIROPRACTIC & MASSAGE THERAPY
Entity Type:Organization
Organization Name:EAST VANCOUVER CHIROPRACTIC & MASSAGE THERAPY
Other - Org Name:EAST VANCOUVER CHIROPRACTIC, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:PECK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-718-8240
Mailing Address - Street 1:13025 NE FOURTH PLAIN BLVD.
Mailing Address - Street 2:SUITE 102
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682
Mailing Address - Country:US
Mailing Address - Phone:360-718-8240
Mailing Address - Fax:360-718-8241
Practice Address - Street 1:13025 NE FOURTH PLAIN
Practice Address - Street 2:SUITE 102
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98682
Practice Address - Country:US
Practice Address - Phone:360-718-8240
Practice Address - Fax:360-718-8241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-19
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00033852111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAU78708Medicare UPIN