Provider Demographics
NPI:1003004375
Name:KENNETH H. CYR
Entity Type:Organization
Organization Name:KENNETH H. CYR
Other - Org Name:FAMILY CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:H
Authorized Official - Last Name:CYR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:509-332-1550
Mailing Address - Street 1:1256 SE BISHOP BLVD
Mailing Address - Street 2:SUITE N
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-5414
Mailing Address - Country:US
Mailing Address - Phone:509-332-1550
Mailing Address - Fax:509-334-6768
Practice Address - Street 1:1256 SE BISHOP BLVD
Practice Address - Street 2:SUITE N
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-5414
Practice Address - Country:US
Practice Address - Phone:509-332-1550
Practice Address - Fax:509-334-6768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002098111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAT02437Medicare UPIN
WAGAB21378Medicare PIN