Provider Demographics
NPI:1134304306
Name:CHAD BOOTH CHIROPRACTIC PC
Entity Type:Organization
Organization Name:CHAD BOOTH CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:BOOTH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-733-8822
Mailing Address - Street 1:1114 FINNEGAN WAY
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-6622
Mailing Address - Country:US
Mailing Address - Phone:360-733-8822
Mailing Address - Fax:360-733-8843
Practice Address - Street 1:1224 HARRIS AVE
Practice Address - Street 2:STE 107
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-7152
Practice Address - Country:US
Practice Address - Phone:360-733-8822
Practice Address - Fax:360-733-8843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034312111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8804231Medicare PIN