Provider Demographics
NPI:1679516371
Name:ABSOLUTE LIFE CHIROPRACTIC
Entity type:Organization
Organization Name:ABSOLUTE LIFE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:DREILING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-260-6903
Mailing Address - Street 1:8115 NE VAN MALL DR #10
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-6787
Mailing Address - Country:US
Mailing Address - Phone:360-260-6903
Mailing Address - Fax:360-260-4849
Practice Address - Street 1:8115 NE VANCOUVER MALL DR #10
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-6787
Practice Address - Country:US
Practice Address - Phone:360-260-6903
Practice Address - Fax:360-260-4849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034526111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty