Provider Demographics
NPI:1326312935
Name:HARDESTY CHIROPRACTIC, PS
Entity Type:Organization
Organization Name:HARDESTY CHIROPRACTIC, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:HARDESTY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-653-2312
Mailing Address - Street 1:PO BOX 295
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-0295
Mailing Address - Country:US
Mailing Address - Phone:360-653-2312
Mailing Address - Fax:360-653-9055
Practice Address - Street 1:6031 47TH AVE NE
Practice Address - Street 2:SUITE B
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-5168
Practice Address - Country:US
Practice Address - Phone:360-653-2312
Practice Address - Fax:360-653-7055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-29
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1967111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA001200327Medicare PIN