Provider Demographics
NPI:1013042316
Name:CHIROPRACTIC CARE CENTER NW PS INC
Entity Type:Organization
Organization Name:CHIROPRACTIC CARE CENTER NW PS INC
Other - Org Name:CHIROPRACTIC CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-844-5671
Mailing Address - Street 1:1905 SE 192ND AVE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-7484
Mailing Address - Country:US
Mailing Address - Phone:360-844-5671
Mailing Address - Fax:360-954-5413
Practice Address - Street 1:1905 SE 192ND AVE
Practice Address - Street 2:SUITE 111
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-7484
Practice Address - Country:US
Practice Address - Phone:360-844-5671
Practice Address - Fax:360-954-5413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA601928781OtherUNIFIED BUSINESS ID NUMBE
WAAB35531Medicare ID - Type Unspecified