Provider Demographics
NPI:1245576008
Name:AXIS CHIROPRACTIC CLINIC, PS
Entity Type:Organization
Organization Name:AXIS CHIROPRACTIC CLINIC, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:VERNON
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:KACZMARSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:206-241-2225
Mailing Address - Street 1:3459 S 152ND ST
Mailing Address - Street 2:
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98188-2176
Mailing Address - Country:US
Mailing Address - Phone:206-241-2225
Mailing Address - Fax:206-241-5562
Practice Address - Street 1:3459 S 152ND ST
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-2176
Practice Address - Country:US
Practice Address - Phone:206-241-2225
Practice Address - Fax:206-241-5562
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AXIS CHIROPRACTIC CLINIC, PS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-12-26
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002546111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0306831OtherDEPT. OF LABOR & INDUSTRIES
WA391945651OtherAMERICAN WHOLEHEALTH NETWORK
WAKA0067OtherBLUE CROSS/BLUE SHIELD
WA2014876Medicaid
WA2014876Medicaid