Provider Demographics
NPI:1932326683
Name:QUANTUM CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:QUANTUM CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR (MANAGING MEMEBER)
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:SHEARER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-944-4437
Mailing Address - Street 1:17720 SE MILL PLAIN BLVD STE 160
Mailing Address - Street 2:SUITE 160
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-7585
Mailing Address - Country:US
Mailing Address - Phone:360-944-4437
Mailing Address - Fax:360-944-3925
Practice Address - Street 1:17720 SE MILL PLAIN BLVD STE 160
Practice Address - Street 2:SUITE 160
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-7585
Practice Address - Country:US
Practice Address - Phone:360-944-4437
Practice Address - Fax:360-944-3925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034737111N00000X
WACH00034738111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8869943Medicare PIN