Provider Demographics
NPI:1285818021
Name:PRO HEALTH CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:PRO HEALTH CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JANELLE
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:HAVELKA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-671-5644
Mailing Address - Street 1:1486 ELECTRIC AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229-2410
Mailing Address - Country:US
Mailing Address - Phone:360-671-5644
Mailing Address - Fax:360-715-2864
Practice Address - Street 1:1486 ELECTRIC AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98229-2410
Practice Address - Country:US
Practice Address - Phone:360-671-5644
Practice Address - Fax:360-715-2864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty