Provider Demographics
NPI:1588694863
Name:NORTHWEST CHIROPRACTIC CLINIC PS
Entity type:Organization
Organization Name:NORTHWEST CHIROPRACTIC CLINIC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:RINDAL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-424-8115
Mailing Address - Street 1:1601A WILLIAM WAY
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-2500
Mailing Address - Country:US
Mailing Address - Phone:360-424-8115
Mailing Address - Fax:360-428-0104
Practice Address - Street 1:1601 WILLIAM WAY STE A
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-2500
Practice Address - Country:US
Practice Address - Phone:360-424-8115
Practice Address - Fax:360-428-0104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001459111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8860443Medicare PIN