Provider Demographics
NPI:1043524960
Name:CK CHIROPRACTIC OFFICE, P.S.
Entity Type:Organization
Organization Name:CK CHIROPRACTIC OFFICE, P.S.
Other - Org Name:BROOKLYN HEIGHTS CHIROPRACTIC OFFICE, P.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:SIEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-692-0181
Mailing Address - Street 1:2851 NW KITSAP PL
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-9447
Mailing Address - Country:US
Mailing Address - Phone:360-692-0181
Mailing Address - Fax:360-692-3847
Practice Address - Street 1:2851 NW KITSAP PL
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-9447
Practice Address - Country:US
Practice Address - Phone:360-692-0181
Practice Address - Fax:360-692-3847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-03
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60070004111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8892209Medicare PIN