Provider Demographics
NPI:1366610727
Name:AUBURN VALLEY CHIROPRACTIC PS
Entity type:Organization
Organization Name:AUBURN VALLEY CHIROPRACTIC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:L
Authorized Official - Last Name:WHITE PS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:253-859-0100
Mailing Address - Street 1:4508 AUBURN WAY N #C
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-1381
Mailing Address - Country:US
Mailing Address - Phone:253-859-0100
Mailing Address - Fax:253-373-9600
Practice Address - Street 1:4508 AUBURN WAY N
Practice Address - Street 2:SUITE C
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-1381
Practice Address - Country:US
Practice Address - Phone:253-859-0100
Practice Address - Fax:253-373-9600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH0001238111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty