Provider Demographics
NPI:1265668628
Name:ABSOLUTE CHIROPRACTIC INC
Entity Type:Organization
Organization Name:ABSOLUTE CHIROPRACTIC INC
Other - Org Name:ABSOLUTE CHIROPRACTIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:LU
Authorized Official - Last Name:CLEMENS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-757-7463
Mailing Address - Street 1:312 GARDNER RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98233-1531
Mailing Address - Country:US
Mailing Address - Phone:360-757-7463
Mailing Address - Fax:360-757-6117
Practice Address - Street 1:312 GARDNER RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98233-1531
Practice Address - Country:US
Practice Address - Phone:360-757-7463
Practice Address - Fax:360-757-7171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-29
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002949111N00000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty