Provider Demographics
NPI:1114372117
Name:ICHIRO PLLC
Entity Type:Organization
Organization Name:ICHIRO PLLC
Other - Org Name:IDEAL MOTION CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-614-9939
Mailing Address - Street 1:18008 STATE ROUTE 410 E
Mailing Address - Street 2:SUITE D
Mailing Address - City:BONNEY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98391-7113
Mailing Address - Country:US
Mailing Address - Phone:253-447-8440
Mailing Address - Fax:253-987-7444
Practice Address - Street 1:18008 STATE ROUTE 410 E
Practice Address - Street 2:SUITE D
Practice Address - City:BONNEY LAKE
Practice Address - State:WA
Practice Address - Zip Code:98391-7113
Practice Address - Country:US
Practice Address - Phone:253-447-8440
Practice Address - Fax:253-987-7444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-27
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60039572111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty