Provider Demographics
NPI:1508630740
Name:BAYSHORE CHIRO PC
Entity Type:Organization
Organization Name:BAYSHORE CHIRO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:MAXIMILIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BICOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:425-229-7232
Mailing Address - Street 1:1121 SE DOCK ST
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-4067
Mailing Address - Country:US
Mailing Address - Phone:360-675-1066
Mailing Address - Fax:
Practice Address - Street 1:1121 SE DOCK ST
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-4067
Practice Address - Country:US
Practice Address - Phone:360-675-1066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty