| Provasoli Chiropractic | |
|
1018 7th Ave Se Olympia WA 98501-1512 | |
| (360) 459-8114 | |
| Not Available |
| Full Name | Provasoli Chiropractic |
|---|---|
| Speciality | Clinic/Center |
| Location | 1018 7th Ave Se, Olympia, Washington |
| Authorized Official Name and Position | Mark Den Hartog (OWNER/CHIROPRACTOR) |
| Authorized Official Contact | 5158220405 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Provasoli Chiropractic 1018 7th Ave Se Olympia WA 98501-1512 Ph: (515) 822-0405 | Provasoli Chiropractic 1018 7th Ave Se Olympia WA 98501-1512 Ph: (360) 459-8114 |
| NPI Number | 1366940645 |
|---|---|
| Provider Enumeration Date | 02/01/2018 |
| Last Update Date | 02/01/2018 |
| Medicare PECOS PAC ID | 1355603226 |
|---|---|
| Medicare Enrollment ID | O20180313002390 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366940645 | NPI | - | NPPES |
| 1023081155 | Other | WA | CHIROPRACTOR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 60741817 (Washington) | Primary |
| Provider Name | Mark J Den Hartog |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1023081155 PECOS PAC ID: 7618910738 Enrollment ID: I20180314001022 |
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