Provider Demographics
NPI:1275999740
Name:HASLAM CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:HASLAM CHIROPRACTIC PLLC
Other - Org Name:CHEWELAH FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:HASLAM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:509-935-6822
Mailing Address - Street 1:PO BOX 1133
Mailing Address - Street 2:301 E. CLAY AVE SUITE 219
Mailing Address - City:CHEWELAH
Mailing Address - State:WA
Mailing Address - Zip Code:99109-1133
Mailing Address - Country:US
Mailing Address - Phone:509-935-6822
Mailing Address - Fax:509-935-4885
Practice Address - Street 1:301 E CLAY AVE STE 219
Practice Address - Street 2:
Practice Address - City:CHEWELAH
Practice Address - State:WA
Practice Address - Zip Code:99109-8936
Practice Address - Country:US
Practice Address - Phone:509-936-6822
Practice Address - Fax:509-936-4885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH-60404828261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center