Provider Demographics
NPI:1093931222
Name:GITHENS CHIROPRACTIC CLINIC, INC.
Entity Type:Organization
Organization Name:GITHENS CHIROPRACTIC CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DUANE
Authorized Official - Middle Name:F
Authorized Official - Last Name:GITHENS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:253-752-3484
Mailing Address - Street 1:5702 N 26TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98407-2406
Mailing Address - Country:US
Mailing Address - Phone:253-752-3484
Mailing Address - Fax:253-752-2930
Practice Address - Street 1:5702 N 26TH ST STE B
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98407-2406
Practice Address - Country:US
Practice Address - Phone:243-752-3484
Practice Address - Fax:253-752-2930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001694111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAT01608Medicare UPIN
WA8859576Medicare ID - Type Unspecified