1598846040 NPI number — THE CHIROPRACTORS CLINIC, P.S.

Table of content: (NPI 1598846040)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598846040 NPI number — THE CHIROPRACTORS CLINIC, P.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE CHIROPRACTORS CLINIC, P.S.
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:
1598846040
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 483
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SILVERDALE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98383
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-698-3140
Provider Business Mailing Address Fax Number:
360-692-1441

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3595 NW BUCKIN HILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SILVERDALE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98383-8503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-698-3140
Provider Business Practice Location Address Fax Number:
360-692-1441
Provider Enumeration Date:
10/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
STEDMAN
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
W
Authorized Official Title or Position:
CLINIC DIRECTOR
Authorized Official Telephone Number:
360-698-3140

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CH00001522 , 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: 192005900 . This is a "OWCP" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 54151 . This is a "LTI" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: ========= . This is a "KPS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 203760203760 . This is a "PREMERA BLUE CROSS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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