Provider Demographics
NPI:1396886495
Name:WEST SOUND CHIROPRACTIC CLINIC PLLC
Entity type:Organization
Organization Name:WEST SOUND CHIROPRACTIC CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PART OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:W
Authorized Official - Last Name:NILES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-895-7744
Mailing Address - Street 1:1008 BETHEL AVE
Mailing Address - Street 2:STE A
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-4235
Mailing Address - Country:US
Mailing Address - Phone:360-895-7744
Mailing Address - Fax:360-895-1166
Practice Address - Street 1:1008 BETHEL AVE
Practice Address - Street 2:STE A
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-4235
Practice Address - Country:US
Practice Address - Phone:360-895-7744
Practice Address - Fax:360-895-1166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3143111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8804937Medicare PIN