Provider Demographics
NPI:1235461559
Name:DESCHUTES CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:DESCHUTES CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-489-0635
Mailing Address - Street 1:PO BOX 4339
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-0339
Mailing Address - Country:US
Mailing Address - Phone:360-489-0635
Mailing Address - Fax:360-489-0917
Practice Address - Street 1:509 CUSTER WAY SE
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98501-3332
Practice Address - Country:US
Practice Address - Phone:360-489-0635
Practice Address - Fax:360-489-0917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-11
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWA3456111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty