Provider Demographics
NPI:1235353897
Name:SALLY JANE PS
Entity Type:Organization
Organization Name:SALLY JANE PS
Other - Org Name:GATEWAY CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:NILES
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-982-2881
Mailing Address - Street 1:1101 8TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-1800
Mailing Address - Country:US
Mailing Address - Phone:360-982-2881
Mailing Address - Fax:360-899-5846
Practice Address - Street 1:1101 8TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-1800
Practice Address - Country:US
Practice Address - Phone:360-982-2881
Practice Address - Fax:360-899-5846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2019-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty