Provider Demographics
NPI:1053671511
Name:CHIROPRACTIC WELLNESS PS INC
Entity Type:Organization
Organization Name:CHIROPRACTIC WELLNESS PS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:509-926-7789
Mailing Address - Street 1:618 N SULLIVAN RD STE 21
Mailing Address - Street 2:ADDRESS 2
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99037-8528
Mailing Address - Country:US
Mailing Address - Phone:509-926-7789
Mailing Address - Fax:509-926-7576
Practice Address - Street 1:618 N SULLIVAN RD STE 21
Practice Address - Street 2:ADDRESS 2
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99037-8528
Practice Address - Country:US
Practice Address - Phone:509-926-7789
Practice Address - Fax:509-926-7576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-17
Last Update Date:2017-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH3411111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAU67704Medicare UPIN
WAGAB01937Medicare PIN