Provider Demographics
NPI:1003146200
Name:ISLAND CREST CHIROPRACTIC INC
Entity Type:Organization
Organization Name:ISLAND CREST CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHANDLESS
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:206-232-2000
Mailing Address - Street 1:2825 80TH AVE SE
Mailing Address - Street 2:STE 2
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-2985
Mailing Address - Country:US
Mailing Address - Phone:206-232-2000
Mailing Address - Fax:
Practice Address - Street 1:2825 80TH AVE SE
Practice Address - Street 2:STE 2
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-2985
Practice Address - Country:US
Practice Address - Phone:206-232-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-11
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty