Provider Demographics
NPI:1225131006
Name:TOPPENISH CHIROPRACTIC CLINIC PS
Entity Type:Organization
Organization Name:TOPPENISH CHIROPRACTIC CLINIC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAIN
Authorized Official - Prefix:DR
Authorized Official - First Name:DON
Authorized Official - Middle Name:E
Authorized Official - Last Name:BERRETH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:509-865-5636
Mailing Address - Street 1:604 W 4TH AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:TOPPENISH
Mailing Address - State:WA
Mailing Address - Zip Code:98948-1673
Mailing Address - Country:US
Mailing Address - Phone:509-865-5636
Mailing Address - Fax:509-865-2053
Practice Address - Street 1:604 W 4TH AVE
Practice Address - Street 2:SUITE B
Practice Address - City:TOPPENISH
Practice Address - State:WA
Practice Address - Zip Code:98948-1673
Practice Address - Country:US
Practice Address - Phone:509-865-5636
Practice Address - Fax:509-865-2053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1345111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T02051Medicare UPIN
WAG8801449Medicare ID - Type Unspecified