Provider Demographics
NPI:1578595179
Name:ACCIDENT & INJURY CHIROPRACTIC CENTER INC.
Entity Type:Organization
Organization Name:ACCIDENT & INJURY CHIROPRACTIC CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:VRANNA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:253-474-0677
Mailing Address - Street 1:1702 S 72ND ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98408-1238
Mailing Address - Country:US
Mailing Address - Phone:253-474-0677
Mailing Address - Fax:253-474-3540
Practice Address - Street 1:1702 S 72ND ST
Practice Address - Street 2:SUITE A
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98408-1238
Practice Address - Country:US
Practice Address - Phone:253-474-0677
Practice Address - Fax:253-474-3540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602010653111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACK3813OtherRAILROAD MEDICARE
WA2010924Medicaid
WA134324OtherSTATE LABOR & INDUSTRIES
WA134324OtherSTATE LABOR & INDUSTRIES
WA2010924Medicaid