Provider Demographics
NPI:1427045566
Name:CHAMPION FAMILY CHIROPRACTIC,
Entity Type:Organization
Organization Name:CHAMPION FAMILY CHIROPRACTIC,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:CHAMPION
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:509-935-2225
Mailing Address - Street 1:PO BOX 203
Mailing Address - Street 2:
Mailing Address - City:CHEWELAH
Mailing Address - State:WA
Mailing Address - Zip Code:99109-0203
Mailing Address - Country:US
Mailing Address - Phone:509-935-2225
Mailing Address - Fax:509-935-2273
Practice Address - Street 1:103 E MAIN AVE
Practice Address - Street 2:
Practice Address - City:CHEWELAH
Practice Address - State:WA
Practice Address - Zip Code:99109-8960
Practice Address - Country:US
Practice Address - Phone:509-935-2225
Practice Address - Fax:509-935-2273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-04
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00033990111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0144619OtherWORK COMP
WA2024990Medicaid
WAGAB38619Medicare PIN