Provider Demographics
NPI:1326323155
Name:EASTSIDE CHIROPRACTIC PC
Entity Type:Organization
Organization Name:EASTSIDE CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHREYER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:425-488-3477
Mailing Address - Street 1:11801 NE 160TH ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-4106
Mailing Address - Country:US
Mailing Address - Phone:425-488-3477
Mailing Address - Fax:425-481-8031
Practice Address - Street 1:11801 NE 160TH ST
Practice Address - Street 2:SUITE D
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-4106
Practice Address - Country:US
Practice Address - Phone:425-488-3477
Practice Address - Fax:425-481-8031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-12
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2632111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty