Provider Demographics
NPI:1083896468
Name:CHIROPRACTIC PAIN RELIEF CLINIC, PS
Entity Type:Organization
Organization Name:CHIROPRACTIC PAIN RELIEF CLINIC, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MILAN
Authorized Official - Middle Name:
Authorized Official - Last Name:STOJAKOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-568-3121
Mailing Address - Street 1:PO BOX 1151
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98291-1151
Mailing Address - Country:US
Mailing Address - Phone:360-568-3121
Mailing Address - Fax:360-568-9334
Practice Address - Street 1:1207 13TH ST
Practice Address - Street 2:SUITE G
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-2000
Practice Address - Country:US
Practice Address - Phone:360-568-3121
Practice Address - Fax:360-568-9334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH33870111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8854256Medicare PIN