Provider Demographics
NPI:1992707715
Name:LAIRD, BRUCE M (DC)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:M
Last Name:LAIRD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 N. CHELAN STREET
Mailing Address - Street 2:#A
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801
Mailing Address - Country:US
Mailing Address - Phone:509-663-0055
Mailing Address - Fax:509-664-8975
Practice Address - Street 1:714 N. CHELAN STREET
Practice Address - Street 2:#A
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801
Practice Address - Country:US
Practice Address - Phone:509-663-0055
Practice Address - Fax:509-664-8975
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001499111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0149153OtherLABOR & INDUSTRIES
WA350052174OtherRAILROAD MEDICARE
WAGAB21942OtherMEDICARE
WA350052174OtherRAILROAD MEDICARE