Provider Demographics
NPI:1386315448
Name:BLAINE CHIROPRACTIC WELLNESS PLLC
Entity type:Organization
Organization Name:BLAINE CHIROPRACTIC WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:ANDRUSCAVAGE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-305-1441
Mailing Address - Street 1:245 H ST
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:WA
Mailing Address - Zip Code:98230-4021
Mailing Address - Country:US
Mailing Address - Phone:360-332-1086
Mailing Address - Fax:360-332-6071
Practice Address - Street 1:245 H ST
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:WA
Practice Address - Zip Code:98230-4021
Practice Address - Country:US
Practice Address - Phone:360-332-1086
Practice Address - Fax:360-332-6071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty