Provider Demographics
NPI:1558484592
Name:NORTH PENINSULA CHIROPRACTIC
Entity Type:Organization
Organization Name:NORTH PENINSULA CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:HAMBLET
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-697-2327
Mailing Address - Street 1:20696 BOND RD NE STE 210
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-9025
Mailing Address - Country:US
Mailing Address - Phone:360-697-2327
Mailing Address - Fax:
Practice Address - Street 1:20696 BOND RD NE STE 210
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-9025
Practice Address - Country:US
Practice Address - Phone:360-697-2327
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0197874OtherL&I
WA0197874OtherL&I
WA=========OtherTAX ID