Provider Demographics
NPI:1326228016
Name:BC DC PS
Entity Type:Organization
Organization Name:BC DC PS
Other - Org Name:INLINE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:CHARLTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:425-825-1750
Mailing Address - Street 1:11725 124TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-8108
Mailing Address - Country:US
Mailing Address - Phone:425-825-1750
Mailing Address - Fax:425-825-1850
Practice Address - Street 1:11725 124TH AVE NE
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-8108
Practice Address - Country:US
Practice Address - Phone:425-825-1750
Practice Address - Fax:425-825-1850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-09
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034368111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA226279OtherLABOR AND INDUSTRIES GRP
WA226279OtherLABOR AND INDUSTRIES GRP