1386783157 NPI number — ROBERT KEITH DOANE LAC

Table of content: ROBERT KEITH DOANE LAC (NPI 1386783157)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386783157 NPI number — ROBERT KEITH DOANE LAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOANE
Provider First Name:
ROBERT
Provider Middle Name:
KEITH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LAC
Provider Gender Code:
M

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:
1386783157
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18870 8TH AVE NE
Provider Second Line Business Mailing Address:
SUITE 108
Provider Business Mailing Address City Name:
POULSBO
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98370-6233
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-394-4357
Provider Business Mailing Address Fax Number:
360-394-7972

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18870 8TH AVE NE
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
POULSBO
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98370-6233
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-394-4357
Provider Business Practice Location Address Fax Number:
360-394-7972
Provider Enumeration Date:
02/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  AC00000434 , 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: AC00000434 . This is a "LICENSE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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