Provider Demographics
NPI:1104907948
Name:OLYMPIC CHIROPRACTIC INC. P.S.
Entity type:Organization
Organization Name:OLYMPIC CHIROPRACTIC INC. P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-532-0888
Mailing Address - Street 1:2017 SUMNER AVE
Mailing Address - Street 2:
Mailing Address - City:HOQUIAM
Mailing Address - State:WA
Mailing Address - Zip Code:98550-2725
Mailing Address - Country:US
Mailing Address - Phone:360-532-0888
Mailing Address - Fax:360-532-4324
Practice Address - Street 1:2017 SUMNER AVE
Practice Address - Street 2:
Practice Address - City:HOQUIAM
Practice Address - State:WA
Practice Address - Zip Code:98550-2725
Practice Address - Country:US
Practice Address - Phone:360-532-0888
Practice Address - Fax:360-532-4324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2519111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAU11512Medicare UPIN
WA8854738Medicare ID - Type Unspecified