Provider Demographics
NPI:1043554157
Name:GOLDENDALE CHIROPRACTIC & NATURAL MEDICINE, LLC
Entity type:Organization
Organization Name:GOLDENDALE CHIROPRACTIC & NATURAL MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:CARVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-773-5633
Mailing Address - Street 1:216 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GOLDENDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98620-9587
Mailing Address - Country:US
Mailing Address - Phone:509-773-5633
Mailing Address - Fax:509-773-5844
Practice Address - Street 1:216 W MAIN ST
Practice Address - Street 2:
Practice Address - City:GOLDENDALE
Practice Address - State:WA
Practice Address - Zip Code:98620-9587
Practice Address - Country:US
Practice Address - Phone:509-773-5633
Practice Address - Fax:509-773-5844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT60221557175F00000X
WAMA60281480174400000X
WANT60083768175F00000X
WAMA00014782174400000X
WA000874111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty