Provider Demographics
NPI:1306072897
Name:CHIROPRACTIC ARTS,P.S.
Entity type:Organization
Organization Name:CHIROPRACTIC ARTS,P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:L J
Authorized Official - Last Name:RANDALL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-943-4797
Mailing Address - Street 1:100 RUBY ST SE STE F
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98501-6724
Mailing Address - Country:US
Mailing Address - Phone:360-943-4797
Mailing Address - Fax:360-709-0542
Practice Address - Street 1:100 RUBY ST SE STE F
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98501-6724
Practice Address - Country:US
Practice Address - Phone:360-943-4797
Practice Address - Fax:360-709-0542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-10
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001228111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty