Provider Demographics
NPI:1386861003
Name:LAIRD CHIROPRACTIC P.S.
Entity Type:Organization
Organization Name:LAIRD CHIROPRACTIC P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATIENT ACCOUNTS
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARROL
Authorized Official - Middle Name:I
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-663-0055
Mailing Address - Street 1:640 N MILLER ST
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-2044
Mailing Address - Country:US
Mailing Address - Phone:509-663-0055
Mailing Address - Fax:509-664-8975
Practice Address - Street 1:640 N MILLER ST
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-2044
Practice Address - Country:US
Practice Address - Phone:509-663-0055
Practice Address - Fax:509-664-8975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0217851OtherLABOR & INDUSTRIES
WA1386861003OtherNPI
WAT02483Medicare UPIN
WAAB21942Medicare ID - Type Unspecified