Provider Demographics
NPI:1063619278
Name:VILLAGE CHIROPRACTIC CENTER
Entity type:Organization
Organization Name:VILLAGE CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:SLEIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-221-5141
Mailing Address - Street 1:PO BOX 527
Mailing Address - Street 2:
Mailing Address - City:LANGLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98260-0527
Mailing Address - Country:US
Mailing Address - Phone:360-221-5141
Mailing Address - Fax:360-221-6242
Practice Address - Street 1:221 2ND STREET
Practice Address - Street 2:SUITE 3
Practice Address - City:LANGLEY
Practice Address - State:WA
Practice Address - Zip Code:98260-0527
Practice Address - Country:US
Practice Address - Phone:360-221-5141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-29
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001234111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB33154Medicare PIN