Provider Demographics
NPI:1073778122
Name:WASHINGTON CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:WASHINGTON CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:BULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:202-966-9280
Mailing Address - Street 1:5008 CONNECTICUT AVE NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-2063
Mailing Address - Country:US
Mailing Address - Phone:202-966-9280
Mailing Address - Fax:202-966-9380
Practice Address - Street 1:5008 CONNECTICUT AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-2063
Practice Address - Country:US
Practice Address - Phone:202-966-9280
Practice Address - Fax:202-966-9380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-28
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCCH21732261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC00B022W91Medicare PIN