Provider Demographics
NPI:1154788511
Name:FOUNDATION CHIROPRACTIC P.S.
Entity type:Organization
Organization Name:FOUNDATION CHIROPRACTIC P.S.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSTIN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:SCHREINER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:253-269-0261
Mailing Address - Street 1:1118 OUTLET COLLECTION WAY
Mailing Address - Street 2:STE 101
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98001
Mailing Address - Country:US
Mailing Address - Phone:253-269-0261
Mailing Address - Fax:253-269-0202
Practice Address - Street 1:1118 OUTLET COLLECTION WAY
Practice Address - Street 2:STE 101
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98001
Practice Address - Country:US
Practice Address - Phone:253-269-0261
Practice Address - Fax:253-269-0202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-15
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH 60101664111N00000X
WACH 60089456111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty