Provider Demographics
NPI:1407251515
Name:STAMPER CHIROPRACTIC
Entity Type:Organization
Organization Name:STAMPER CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:STAMPER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-452-7827
Mailing Address - Street 1:106 W LAURIDSEN BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-7752
Mailing Address - Country:US
Mailing Address - Phone:360-452-7827
Mailing Address - Fax:360-452-5379
Practice Address - Street 1:106 W LAURIDSEN BLVD
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-7752
Practice Address - Country:US
Practice Address - Phone:360-452-7827
Practice Address - Fax:360-452-5379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-31
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60176128111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8894601Medicare PIN