Provider Demographics
NPI:1093227977
Name:509 CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:509 CHIROPRACTIC LLC
Other - Org Name:HEALTHSOURCE CHIROPRACTIC OF PASCO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHON
Authorized Official - Middle Name:MERRELL
Authorized Official - Last Name:HESLOP
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:509-346-5822
Mailing Address - Street 1:1211 N 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-4051
Mailing Address - Country:US
Mailing Address - Phone:509-547-1759
Mailing Address - Fax:
Practice Address - Street 1:1211 N 20TH AVE
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-4051
Practice Address - Country:US
Practice Address - Phone:509-547-1759
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-31
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60789723111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0403568OtherLNI NUMBER
WA60789723OtherCHIROPRACTIC LICENSE