Provider Demographics
NPI:1003099011
Name:HARBOR HEALING ARTS PLLC
Entity Type:Organization
Organization Name:HARBOR HEALING ARTS PLLC
Other - Org Name:HABOR HEALING ARTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:B
Authorized Official - Last Name:HALLAWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:253-851-3311
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:WAUNA
Mailing Address - State:WA
Mailing Address - Zip Code:98395-0130
Mailing Address - Country:US
Mailing Address - Phone:253-851-3311
Mailing Address - Fax:
Practice Address - Street 1:13214 150TH STREET KP N
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98329-4668
Practice Address - Country:US
Practice Address - Phone:253-851-3311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-12
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA34020261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8879872OtherMEDICARE PTAN
WAG8879872OtherMEDICARE PTAN
WAG8879872Medicare PIN