Provider Demographics
NPI:1437374725
Name:DIRMEYER CHIROPRACTIC WELLNESS CLINIC
Entity Type:Organization
Organization Name:DIRMEYER CHIROPRACTIC WELLNESS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:DIRMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-697-3737
Mailing Address - Street 1:20307 VIKING AVE NW STE 102
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-8321
Mailing Address - Country:US
Mailing Address - Phone:360-697-3737
Mailing Address - Fax:360-779-6337
Practice Address - Street 1:20307 VIKING AVE NW STE 102
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-8321
Practice Address - Country:US
Practice Address - Phone:360-697-3737
Practice Address - Fax:360-779-6337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001591111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA37270OtherLABOR AND INDUSTRIES
WA37270OtherLABOR AND INDUSTRIES