Provider Demographics
NPI:1194361469
Name:COLUMBIA CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:COLUMBIA CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNERE
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:509-662-0309
Mailing Address - Street 1:1303 PRINCETON AVE N
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-1438
Mailing Address - Country:US
Mailing Address - Phone:509-662-0309
Mailing Address - Fax:509-664-8962
Practice Address - Street 1:1303 PRINCETON AVE N
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-1438
Practice Address - Country:US
Practice Address - Phone:509-662-0309
Practice Address - Fax:509-664-8962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-21
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2039600Medicaid
WA16232OtherLABOR AND INDUSTRIES