Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | MA000181888 | WA |
NPI | 1003209859 |
---|---|
Provider Name | Mrs. Oksana I Bondarenko |
First Address | Vancouver, WA 98685-2818 |
Second Address | Vancouver, WA 98685-2818 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2015 |
Last Update Date | 24/03/2015 |