Provider Demographics
NPI:1033443791
Name:PLANET CHIROPRACTIC INC
Entity Type:Organization
Organization Name:PLANET CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:MCCORMICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:425-760-2205
Mailing Address - Street 1:15224 MAIN ST STE 103
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-7316
Mailing Address - Country:US
Mailing Address - Phone:425-760-2205
Mailing Address - Fax:425-379-0180
Practice Address - Street 1:15224 MAIN ST STE 103
Practice Address - Street 2:
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-7316
Practice Address - Country:US
Practice Address - Phone:425-760-2205
Practice Address - Fax:425-379-0180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-29
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8855118Medicare PIN