Provider Demographics
NPI:1467542274
Name:SILLITO CHIROPRACTIC CENTER, PS
Entity Type:Organization
Organization Name:SILLITO CHIROPRACTIC CENTER, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DERROL
Authorized Official - Middle Name:M
Authorized Official - Last Name:SILLITO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:253-845-4655
Mailing Address - Street 1:5511 112TH AVENUE CT E
Mailing Address - Street 2:SUITE B
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-5942
Mailing Address - Country:US
Mailing Address - Phone:253-845-4655
Mailing Address - Fax:253-845-1052
Practice Address - Street 1:5511 112TH AVENUE CT E
Practice Address - Street 2:SUITE B
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-5942
Practice Address - Country:US
Practice Address - Phone:253-845-4655
Practice Address - Fax:253-845-1052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1192111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty