1942294871 NPI number — YAKIMA VALLEY CHIROPRACTIC CENTER PS

Table of content: (NPI 1942294871)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942294871 NPI number — YAKIMA VALLEY CHIROPRACTIC CENTER PS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
YAKIMA VALLEY CHIROPRACTIC CENTER 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:
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:
1942294871
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 54
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUNNYSIDE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98944-0054
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-837-2600
Provider Business Mailing Address Fax Number:
509-837-2291

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1120 S 4TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUNNYSIDE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98944-2185
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-837-2600
Provider Business Practice Location Address Fax Number:
509-837-2291
Provider Enumeration Date:
09/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HARRINGTON
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
DUANE
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
509-837-2600

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 115116501 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8921561 . This is a "CRIME VICTOMS COMP PROGRA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 129386 . This is a "DEPT OF LABOR & INDUSTR." identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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