Provider Demographics
NPI:1467650259
Name:SEQUIM CHIROPRACTIC CLINIC, PC
Entity Type:Organization
Organization Name:SEQUIM CHIROPRACTIC CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:D
Authorized Official - Last Name:BEAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-681-2414
Mailing Address - Street 1:625 N 5TH AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-5062
Mailing Address - Country:US
Mailing Address - Phone:360-681-2414
Mailing Address - Fax:360-681-3279
Practice Address - Street 1:625 N 5TH AVE STE 1
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-5062
Practice Address - Country:US
Practice Address - Phone:360-681-2414
Practice Address - Fax:360-681-3279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-03
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003465111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2026219Medicaid
WA2026219Medicaid
WA8801345Medicare PIN