| Victory Spine And Sport | |
|
16508 Se 24th St Ste 203 Vancouver WA 98683-4321 | |
| (360) 818-4626 | |
| (360) 208-0293 |
| Full Name | Victory Spine And Sport |
|---|---|
| Speciality | Clinic/Center |
| Location | 16508 Se 24th St Ste 203, Vancouver, Washington |
| Authorized Official Name and Position | Dustin Henry (OWNER) |
| Authorized Official Contact | 3608184626 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Victory Spine And Sport 16508 Se 24th St Ste 203 Vancouver WA 98683-4321 Ph: (360) 818-4626 | Victory Spine And Sport 16508 Se 24th St Ste 203 Vancouver WA 98683-4321 Ph: (360) 818-4626 |
| NPI Number | 1780285510 |
|---|---|
| Provider Enumeration Date | 11/06/2020 |
| Last Update Date | 12/02/2021 |
| Medicare PECOS PAC ID | 4183093537 |
|---|---|
| Medicare Enrollment ID | O20221207002302 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780285510 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Dustin Carter Henry |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1891240248 PECOS PAC ID: 5092184440 Enrollment ID: I20221207002361 |
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