1396886495 NPI number — WEST SOUND CHIROPRACTIC CLINIC PLLC

Table of content: (NPI 1396886495)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396886495 NPI number — WEST SOUND CHIROPRACTIC CLINIC PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEST SOUND CHIROPRACTIC CLINIC 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:
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:
1396886495
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/26/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1008 BETHEL AVE
Provider Second Line Business Mailing Address:
STE A
Provider Business Mailing Address City Name:
PORT ORCHARD
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98366-4235
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-895-7744
Provider Business Mailing Address Fax Number:
360-895-1166

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1008 BETHEL AVE
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
PORT ORCHARD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98366-4235
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-895-7744
Provider Business Practice Location Address Fax Number:
360-895-1166
Provider Enumeration Date:
02/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
NILES
Authorized Official First Name:
CATHERINE
Authorized Official Middle Name:
W
Authorized Official Title or Position:
PART OWNER
Authorized Official Telephone Number:
360-895-7744

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  3143 , 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)





Copyright © 2007-2025 www.npivalidator.com