1972556439 NPI number — INTER ISLAND CHIROPRACTIC INC PS

Table of content: (NPI 1972556439)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972556439 NPI number — INTER ISLAND CHIROPRACTIC INC PS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTER ISLAND CHIROPRACTIC INC 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:
1972556439
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/11/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 955
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EASTSOUND
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98245-0955
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-376-2100
Provider Business Mailing Address Fax Number:
360-376-6255

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
441 N BEACH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EASTSOUND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98245-8927
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-376-2100
Provider Business Practice Location Address Fax Number:
360-376-6255
Provider Enumeration Date:
05/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FABIANEK
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
W
Authorized Official Title or Position:
PROPRIETOR
Authorized Official Telephone Number:
360-376-2100

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  602 585 485 , 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: 602 585 485 . This is a "STATE LICENSE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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