Provider Demographics
NPI:1407905300
Name:CHENEY SPINAL CARE PS
Entity Type:Organization
Organization Name:CHENEY SPINAL CARE PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDEN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:F
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:509-235-2122
Mailing Address - Street 1:1951 1ST ST
Mailing Address - Street 2:
Mailing Address - City:CHENEY
Mailing Address - State:WA
Mailing Address - Zip Code:99004-2000
Mailing Address - Country:US
Mailing Address - Phone:509-235-2122
Mailing Address - Fax:509-235-2444
Practice Address - Street 1:1951 1ST ST
Practice Address - Street 2:
Practice Address - City:CHENEY
Practice Address - State:WA
Practice Address - Zip Code:99004-2000
Practice Address - Country:US
Practice Address - Phone:509-235-2122
Practice Address - Fax:509-235-2444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034406111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1013028539OtherINDIVIDUAL NPI