Provider Demographics
NPI:1124360201
Name:PEARL CHIROPRACTIC, PS
Entity Type:Organization
Organization Name:PEARL CHIROPRACTIC, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CORENE
Authorized Official - Middle Name:K
Authorized Official - Last Name:BODILY-GOODMANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:253-970-5077
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:253-970-5077
Mailing Address - Fax:253-327-1296
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:253-970-5077
Practice Address - Fax:253-327-1296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-26
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034815111NN1001X
WAMA00023725225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty