Provider Demographics
NPI:1699121012
Name:SEQUIM FAMILY CHIROPRACTIC CENTER
Entity type:Organization
Organization Name:SEQUIM FAMILY CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:ERICH
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:907-903-1118
Mailing Address - Street 1:415 N SEQUIM AVE
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-3460
Mailing Address - Country:US
Mailing Address - Phone:907-903-1118
Mailing Address - Fax:360-457-3550
Practice Address - Street 1:415 N SEQUIM AVE
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-3460
Practice Address - Country:US
Practice Address - Phone:907-903-1118
Practice Address - Fax:360-457-3550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-05
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH.60535610111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty