1225125651 NPI number — MONROE CHIROPRACTIC AND ALTERNATIVE MEDICINE CENTER PS

Table of content: (NPI 1225125651)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225125651 NPI number — MONROE CHIROPRACTIC AND ALTERNATIVE MEDICINE CENTER PS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MONROE CHIROPRACTIC AND ALTERNATIVE MEDICINE CENTER PS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225125651
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 327
Provider Second Line Business Mailing Address:
328 WEST MAIN STREET
Provider Business Mailing Address City Name:
MONROE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98272
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-794-4500
Provider Business Mailing Address Fax Number:
360-863-1640

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
328 WEST MAINE STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98272
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-794-4500
Provider Business Practice Location Address Fax Number:
360-863-1640
Provider Enumeration Date:
10/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BREWER
Authorized Official First Name:
RACHELLE
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
360-794-4500

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CH00033602 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 402450 . This is a "BLUE CROSS/SHIELD" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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