Provider Demographics
NPI:1376900712
Name:HASLAM CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:HASLAM CHIROPRACTIC PLLC
Other - Org Name:CHEWELAH FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HASLAM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:509-935-6822
Mailing Address - Street 1:PO BOX 1133
Mailing Address - Street 2:
Mailing Address - City:CHEWELAH
Mailing Address - State:WA
Mailing Address - Zip Code:99109-1133
Mailing Address - Country:US
Mailing Address - Phone:509-935-6822
Mailing Address - Fax:509-935-4885
Practice Address - Street 1:301 E CLAY AVE
Practice Address - Street 2:SUITE 219
Practice Address - City:CHEWELAH
Practice Address - State:WA
Practice Address - Zip Code:99109-8936
Practice Address - Country:US
Practice Address - Phone:509-935-6822
Practice Address - Fax:509-935-4885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-15
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH-60404828261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center