Provider Demographics
NPI:1063677573
Name:DENNIS L. BOOTH. D.C., PLLC
Entity Type:Organization
Organization Name:DENNIS L. BOOTH. D.C., PLLC
Other - Org Name:FOURTH STREET CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATING MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:LEO
Authorized Official - Last Name:BOOTH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-659-2938
Mailing Address - Street 1:1606 4TH ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-5042
Mailing Address - Country:US
Mailing Address - Phone:360-659-2938
Mailing Address - Fax:360-658-0135
Practice Address - Street 1:1606 4TH ST
Practice Address - Street 2:SUITE E
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-5042
Practice Address - Country:US
Practice Address - Phone:360-659-2938
Practice Address - Fax:360-658-0135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002945261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service