1790825198 NPI number — VERHUNCE CHIROPRACTIC CORPORATION

Table of content: (NPI 1790825198)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790825198 NPI number — VERHUNCE CHIROPRACTIC CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VERHUNCE CHIROPRACTIC CORPORATION
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:
1790825198
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/08/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21904 MARINE VIEW DR S
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
DES MOINES
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98198-6103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-824-5521
Provider Business Mailing Address Fax Number:
206-212-7455

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21904 MARINE VIEW DR S
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
DES MOINES
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98198-6103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-824-5521
Provider Business Practice Location Address Fax Number:
206-212-7455
Provider Enumeration Date:
02/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
VERHUNCE
Authorized Official First Name:
BONNIE
Authorized Official Middle Name:
JEAN
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
206-824-5521

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  602003024 , 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: 0718VE . This is a "REGENCE RIDER NUMBER" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0134456 . This is a "DEPARTMENT OF LABOR & IND" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 2029312 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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