Provider Demographics
NPI:1114127487
Name:1ST CHOICE CHIROPRACTIC PS
Entity Type:Organization
Organization Name:1ST CHOICE CHIROPRACTIC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:SYREK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-357-5222
Mailing Address - Street 1:2256 MOTTMAN RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98512
Mailing Address - Country:US
Mailing Address - Phone:360-357-5222
Mailing Address - Fax:360-786-9494
Practice Address - Street 1:2256 MOTTMAN RD
Practice Address - Street 2:SUITE C
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98512
Practice Address - Country:US
Practice Address - Phone:360-357-5222
Practice Address - Fax:360-786-9494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00033952111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB29603Medicaid