| Hazel Dell Sports Medicine & Rehab Clinic Pllc | |
|
300 Grand Blvd Ste B200 Vancouver WA 98661-4930 | |
| (360) 573-5500 | |
| (360) 573-9075 |
| Full Name | Hazel Dell Sports Medicine & Rehab Clinic Pllc |
|---|---|
| Speciality | Chiropractor |
| Location | 300 Grand Blvd, Vancouver, Washington |
| Authorized Official Name and Position | Douglas Lee Forgey (OWNER) |
| Authorized Official Contact | 3605735500 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Hazel Dell Sports Medicine & Rehab Clinic Pllc 300 Grand Blvd Ste B200 Vancouver WA 98661-4930 Ph: (360) 573-5500 | Hazel Dell Sports Medicine & Rehab Clinic Pllc 300 Grand Blvd Ste B200 Vancouver WA 98661-4930 Ph: (360) 573-5500 |
| NPI Number | 1902930076 |
|---|---|
| Provider Enumeration Date | 03/14/2007 |
| Last Update Date | 06/08/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902930076 | NPI | - | NPPES |
| 0154878 | Other | WA | DEPARTMENT OF LABOR & IND |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | MD00010276 (Washington) | Secondary |
| 111N00000X | Chiropractor | (Washington) | Primary |
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