Provider Demographics
NPI:1366637233
Name:CASCADES CHIROPRACTIC CENTER INC.
Entity Type:Organization
Organization Name:CASCADES CHIROPRACTIC CENTER INC.
Other - Org Name:DUPONT FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:BS, DC
Authorized Official - Phone:253-964-1325
Mailing Address - Street 1:PO BOX 450
Mailing Address - Street 2:
Mailing Address - City:DUPONT
Mailing Address - State:WA
Mailing Address - Zip Code:98327-0450
Mailing Address - Country:US
Mailing Address - Phone:253-964-1325
Mailing Address - Fax:253-964-1329
Practice Address - Street 1:1570 WILMINGTON DR STE 120
Practice Address - Street 2:
Practice Address - City:DUPONT
Practice Address - State:WA
Practice Address - Zip Code:98327-8773
Practice Address - Country:US
Practice Address - Phone:253-964-1325
Practice Address - Fax:253-964-1329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-13
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00033638111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2032696Medicaid
WA2032696Medicaid
WAU88578Medicare UPIN