Provider Demographics
NPI:1154652311
Name:INSIGHT CHIROPRACTIC WELLNESS CENTER P.S. INC.
Entity type:Organization
Organization Name:INSIGHT CHIROPRACTIC WELLNESS CENTER P.S. INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:WAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-458-2225
Mailing Address - Street 1:PO BOX 3045
Mailing Address - Street 2:
Mailing Address - City:YELM
Mailing Address - State:WA
Mailing Address - Zip Code:98597-3045
Mailing Address - Country:US
Mailing Address - Phone:360-458-2225
Mailing Address - Fax:360-458-3663
Practice Address - Street 1:715 E YELM AVE STE 5
Practice Address - Street 2:
Practice Address - City:YELM
Practice Address - State:WA
Practice Address - Zip Code:98597-8714
Practice Address - Country:US
Practice Address - Phone:360-458-2225
Practice Address - Fax:360-458-3663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-27
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034878111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty