Provider Demographics
NPI:1144417221
Name:JOHN E. DUPPENTHALER, D.C, P.S.
Entity Type:Organization
Organization Name:JOHN E. DUPPENTHALER, D.C, P.S.
Other - Org Name:DUPPENTHALER FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:DUPPENTHALER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:253-857-9100
Mailing Address - Street 1:6659 KIMBALL DR
Mailing Address - Street 2:SUITE A-102
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-5137
Mailing Address - Country:US
Mailing Address - Phone:253-857-9100
Mailing Address - Fax:253-857-3110
Practice Address - Street 1:6659 KIMBALL DR
Practice Address - Street 2:SUITE A-102
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-5137
Practice Address - Country:US
Practice Address - Phone:253-857-9100
Practice Address - Fax:253-857-3110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002479111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty