Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | CH00002709 | WA |
NPI | 1306990460 |
---|---|
Provider Name | Mitchell Powers |
First Address | Vancouver, WA 98686-5697 |
Second Address | Vancouver, WA 98686-5697 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2007 |
Last Update Date | 28/02/2015 |