Nolan Deatherage, DC | |
1101 Supermall Way Ste 1269, Auburn, WA 98001-6535 | |
(253) 269-0261 | |
Not Available |
Full Name | Nolan Deatherage |
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Gender | Male |
Speciality | Chiropractor |
Location | 1101 Supermall Way Ste 1269, Auburn, Washington |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1144467119 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
111N00000X | Chiropractor | CH60040685 (Washington) | Primary |
Provider Name | Deatherage Chiropractic Pllc |
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Provider Type | Part B Supplier - Clinic/group Practice |
Provider Identifiers | NPI Number: 1295497014 PECOS PAC ID: 2961888011 Enrollment ID: O20220927003803 |
Mailing Address | Practice Location Address |
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Nolan Deatherage, DC 1101 Supermall Way Ste 1269, Auburn, WA 98001-6535 Ph: (253) 269-0261 | Nolan Deatherage, DC 1101 Supermall Way Ste 1269, Auburn, WA 98001-6535 Ph: (253) 269-0261 |
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