Provider Demographics
NPI:1497977243
Name:JOHN V COFFEY D C INC P S
Entity Type:Organization
Organization Name:JOHN V COFFEY D C INC P S
Other - Org Name:COFFEY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:V
Authorized Official - Last Name:COFFEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:253-850-2225
Mailing Address - Street 1:4701 AUBURN WAY N
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-1312
Mailing Address - Country:US
Mailing Address - Phone:253-850-2225
Mailing Address - Fax:253-850-5757
Practice Address - Street 1:4701 AUBURN WAY N
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-1312
Practice Address - Country:US
Practice Address - Phone:253-850-2225
Practice Address - Fax:253-850-5757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH0001167111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0129406OtherDEPT OF L&I
WA00100976OtherMEDICARE
WA2054005Medicaid