Provider Demographics
NPI:1083103543
Name:WHOLE HEALTH CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:WHOLE HEALTH CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CHIROPRACTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIRSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:EBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:541-321-5700
Mailing Address - Street 1:1907 GARDEN AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97403-1962
Mailing Address - Country:US
Mailing Address - Phone:541-321-5700
Mailing Address - Fax:541-687-4253
Practice Address - Street 1:1907 GARDEN AVE STE 102
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97403-1962
Practice Address - Country:US
Practice Address - Phone:541-321-5700
Practice Address - Fax:541-687-4253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-09
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5787111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty