1275999740 NPI number — HASLAM CHIROPRACTIC PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275999740 NPI number — HASLAM CHIROPRACTIC PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HASLAM CHIROPRACTIC PLLC
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:
6
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:
1275999740
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1133
Provider Second Line Business Mailing Address:
301 E. CLAY AVE SUITE 219
Provider Business Mailing Address City Name:
CHEWELAH
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99109-1133
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-935-6822
Provider Business Mailing Address Fax Number:
509-935-4885

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 E CLAY AVE STE 219
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHEWELAH
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99109-8936
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-936-6822
Provider Business Practice Location Address Fax Number:
509-936-4885
Provider Enumeration Date:
01/13/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HASLAM
Authorized Official First Name:
BRADLEY
Authorized Official Middle Name:
DAVID
Authorized Official Title or Position:
OWNER/DOCTOR
Authorized Official Telephone Number:
509-935-6822

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  CH-60404828 , 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)