Provider Demographics
NPI:1508149097
Name:CB CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:CB CHIROPRACTIC PLLC
Other - Org Name:FIFE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:BLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-922-0450
Mailing Address - Street 1:4505 PACIFIC HWY E
Mailing Address - Street 2:SUITE B-1
Mailing Address - City:FIFE
Mailing Address - State:WA
Mailing Address - Zip Code:98424-2638
Mailing Address - Country:US
Mailing Address - Phone:253-922-0450
Mailing Address - Fax:253-926-1720
Practice Address - Street 1:4505 PACIFIC HWY E
Practice Address - Street 2:SUITE B-1
Practice Address - City:FIFE
Practice Address - State:WA
Practice Address - Zip Code:98424-2638
Practice Address - Country:US
Practice Address - Phone:253-922-0450
Practice Address - Fax:253-926-1720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-21
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center