Provider Demographics
NPI:1003005653
Name:ACTION CHIROPRATIC
Entity Type:Organization
Organization Name:ACTION CHIROPRATIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:WILLYARD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-876-6865
Mailing Address - Street 1:1501 POTTERY AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-3712
Mailing Address - Country:US
Mailing Address - Phone:360-876-6865
Mailing Address - Fax:360-876-5507
Practice Address - Street 1:1501 POTTERY AVE
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-3712
Practice Address - Country:US
Practice Address - Phone:360-876-6865
Practice Address - Fax:360-876-5507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-19
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003380111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB002571Medicare PIN