Provider Demographics
NPI:1073727509
Name:SELAH FAMILY CHIROPRACTIC P.S.
Entity Type:Organization
Organization Name:SELAH FAMILY CHIROPRACTIC P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR/PRESIDENT/SHAREHOLD
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:LEMMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-697-4123
Mailing Address - Street 1:318 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:SELAH
Mailing Address - State:WA
Mailing Address - Zip Code:98942-1339
Mailing Address - Country:US
Mailing Address - Phone:509-697-4123
Mailing Address - Fax:509-697-4423
Practice Address - Street 1:318 S 1ST ST
Practice Address - Street 2:
Practice Address - City:SELAH
Practice Address - State:WA
Practice Address - Zip Code:98942-1339
Practice Address - Country:US
Practice Address - Phone:509-697-4123
Practice Address - Fax:509-697-4423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001911111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0324466OtherL & I
WA84043OtherLABOR & INDUSTRIES
WA84043OtherLABOR & INDUSTRIES
WA0324466OtherL & I
WAG8918641Medicare PIN