1356520332 NPI number — RAMOS CHIROPRACTIC CLINIC PLLC

Table of content: (NPI 1356520332)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356520332 NPI number — RAMOS CHIROPRACTIC CLINIC PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RAMOS CHIROPRACTIC CLINIC PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356520332
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/26/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
127 S SPRUCE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BURLINGTON
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98233-1712
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-755-9030
Provider Business Mailing Address Fax Number:
360-755-9030

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
127 S SPRUCE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BURLINGTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98233-1712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-755-9030
Provider Business Practice Location Address Fax Number:
360-755-9030
Provider Enumeration Date:
10/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RAMOS
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
360-755-9030

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CH00034437 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0206714 . This is a "LABOR & INDUSTRIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 4247RA . This is a "REGENCE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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