Provider Demographics
NPI:1376083105
Name:PINEHURST CHIROPRACTIC
Entity Type:Organization
Organization Name:PINEHURST CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.C, OWNER, PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:P
Authorized Official - Last Name:KIRDAHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-365-2233
Mailing Address - Street 1:2611 NE 125TH ST STE 115
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-4376
Mailing Address - Country:US
Mailing Address - Phone:206-365-2233
Mailing Address - Fax:206-361-7082
Practice Address - Street 1:2611 NE 125TH ST STE 115
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-4376
Practice Address - Country:US
Practice Address - Phone:206-365-2233
Practice Address - Fax:206-361-7082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-27
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001825111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAKI1751Medicaid
WAKI1751Medicaid