Provider Demographics
NPI:1174547533
Name:VANQUAETHEM, MEISHA K (DC)
Entity type:Individual
Prefix:DR
First Name:MEISHA
Middle Name:K
Last Name:VANQUAETHEM
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2222
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98507-2222
Mailing Address - Country:US
Mailing Address - Phone:360-943-6206
Mailing Address - Fax:360-943-6276
Practice Address - Street 1:1800 COOPER POINT RD SW
Practice Address - Street 2:BLDG. 12
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-1178
Practice Address - Country:US
Practice Address - Phone:360-943-6206
Practice Address - Fax:360-943-6276
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034611111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor