Provider Demographics
NPI:1841470432
Name:WOODLAND CHIROPRACTIC WELLNESS CLINIC, PS
Entity type:Organization
Organization Name:WOODLAND CHIROPRACTIC WELLNESS CLINIC, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:DAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC , CCN
Authorized Official - Phone:360-225-5726
Mailing Address - Street 1:PO BOX 1881
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98674-1800
Mailing Address - Country:US
Mailing Address - Phone:360-225-5726
Mailing Address - Fax:360-225-2253
Practice Address - Street 1:1933 BELMONT LOOP STE C
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:WA
Practice Address - Zip Code:98674-8492
Practice Address - Country:US
Practice Address - Phone:360-225-5726
Practice Address - Fax:360-225-2253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-12
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002773111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty