Provider Demographics
NPI:1235413964
Name:PLANET CHIROPRACTIC INC
Entity Type:Organization
Organization Name:PLANET CHIROPRACTIC INC
Other - Org Name:YAKIMA VALLEY SPINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:MCCORMICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:509-966-3031
Mailing Address - Street 1:15224 MAIN ST STE 103
Mailing Address - Street 2:STE. 103
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-7316
Mailing Address - Country:US
Mailing Address - Phone:425-379-9749
Mailing Address - Fax:425-379-0180
Practice Address - Street 1:205 N 40TH AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-2949
Practice Address - Country:US
Practice Address - Phone:509-966-3031
Practice Address - Fax:509-966-1954
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PLANET CHIROPRACTIC INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-09-29
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034501111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8855118Medicare UPIN