Provider Demographics
NPI:1568610988
Name:SPINE STRENGTH FOR HEALTH CENTER, PLLC
Entity Type:Organization
Organization Name:SPINE STRENGTH FOR HEALTH CENTER, PLLC
Other - Org Name:LIFE CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:OWEN
Authorized Official - Last Name:HARGREAVES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-734-5433
Mailing Address - Street 1:1400 KING ST
Mailing Address - Street 2:105
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229-6262
Mailing Address - Country:US
Mailing Address - Phone:360-734-5433
Mailing Address - Fax:360-734-5435
Practice Address - Street 1:1400 KING ST
Practice Address - Street 2:105
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98229-6262
Practice Address - Country:US
Practice Address - Phone:360-734-5433
Practice Address - Fax:360-734-5435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001968111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8866819Medicare PIN