Provider Demographics
NPI:1194778662
Name:HALBERG CHIROPRACTIC CLINIC, PLLC
Entity type:Organization
Organization Name:HALBERG CHIROPRACTIC CLINIC, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:GUSTAF
Authorized Official - Last Name:HALBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-457-7576
Mailing Address - Street 1:430 E LAURIDSEN BLVD
Mailing Address - Street 2:SUITE 113
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-7978
Mailing Address - Country:US
Mailing Address - Phone:360-457-7576
Mailing Address - Fax:360-452-8079
Practice Address - Street 1:430 E LAURIDSEN BLVD
Practice Address - Street 2:SUITE 113
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-7978
Practice Address - Country:US
Practice Address - Phone:360-457-7576
Practice Address - Fax:360-452-8079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034213111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty