Provider Demographics
NPI:1225125651
Name:MONROE CHIROPRACTIC AND ALTERNATIVE MEDICINE CENTER PS
Entity Type:Organization
Organization Name:MONROE CHIROPRACTIC AND ALTERNATIVE MEDICINE CENTER PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RACHELLE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-794-4500
Mailing Address - Street 1:PO BOX 327
Mailing Address - Street 2:328 WEST MAIN STREET
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272
Mailing Address - Country:US
Mailing Address - Phone:360-794-4500
Mailing Address - Fax:360-863-1640
Practice Address - Street 1:328 WEST MAINE STREET
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272
Practice Address - Country:US
Practice Address - Phone:360-794-4500
Practice Address - Fax:360-863-1640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00033602111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA402450OtherBLUE CROSS/SHIELD
WA402450OtherBLUE CROSS/SHIELD
WA402450OtherBLUE CROSS/SHIELD
WA=========Medicaid