Advanced Chiropractic Centre Corp
Organization Active NPI Sports Physician Chiropractor · Vancouver, WA
NPI 1710032057 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1710032057
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Sports Physician Chiropractor 111NS0005X
- License
- CH00003418 (WA)
- Legal business name
- ADVANCED CHIROPRACTIC CENTRE CORP
- Practice address
- 705 SE Park Crest Ave., Ste A120
Vancouver, WA 98683-1303 - Phone
- (360) 892-3654
- Fax
- (360) 892-3692
- NPI assigned
- Jan 25, 2007
- Organization subpart
- No
Authorized official
- Name
- Larry Lee Wasilenkoff, D.C
- Title
- Owner
- Phone
- (360) 892-3654
Practitioners 4
-
Larry Lee Wasilenkoff, D.C.
-
Sandy M May Vigil, LMT
-
Erin Kristine Swayze, LMP
-
Lyubov Truman, LMP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040408000924 | WA | Part B Supplier - Clinic/Group Practice | 4183618697 |
Receives reassigned benefits from 1 practitioner Practice locations: Vancouver, WA |
National Provider Directory
Locations
225 SW 2nd St
Stevenson, WA 98648
Phone (509) 427-4266
521 SE 155th Ave
Ste 106
Vancouver, WA 98684
Phone (360) 892-3654
705 SE Park Crest Ave
Ste A120
Vancouver, WA 98683
Phone (360) 892-3654
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Physician Chiropractor |
111NS0005X | CH00003418 | WA | Yes |
Addresses
Primary practice location
705 SE Park Crest Ave., Ste A120
Vancouver, WA 98683-1303
Mailing address
705 SE Park Crest Ave., Ste A120
Vancouver, WA 98683-1303
Phone (360) 892-3654
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All providers in Vancouver, WA · Sports Physician Chiropractor in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.