Provider Demographics
NPI:1043365489
Name:BAY CENTER CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:BAY CENTER CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILMOVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-786-6322
Mailing Address - Street 1:2627 CAPITOL MALL DR SW
Mailing Address - Street 2:STEB3A
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-8696
Mailing Address - Country:US
Mailing Address - Phone:360-786-6322
Mailing Address - Fax:360-786-5677
Practice Address - Street 1:2627 CAPITOL MALL DR SW
Practice Address - Street 2:STEB3A
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-8696
Practice Address - Country:US
Practice Address - Phone:360-786-6322
Practice Address - Fax:360-786-5677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002578111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty