Provider Demographics
NPI:1225154610
Name:BOOTH, CHAD (DC)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:
Last Name:BOOTH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9660 OLD HWY 99 N
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98233-6827
Mailing Address - Country:US
Mailing Address - Phone:360-733-8822
Mailing Address - Fax:360-733-8843
Practice Address - Street 1:9660 OLD HWY 99 N
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98233-6827
Practice Address - Country:US
Practice Address - Phone:360-733-8822
Practice Address - Fax:360-733-8843
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034312111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8804233Medicare PIN
WAV00093Medicare UPIN