Provider Demographics
NPI:1578931069
Name:EVERGREEN SPINE AND POSTURE CORRECTION CENTER, LLC
Entity Type:Organization
Organization Name:EVERGREEN SPINE AND POSTURE CORRECTION CENTER, LLC
Other - Org Name:EVERGREEN SPINAL HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:253-683-4277
Mailing Address - Street 1:6615 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-2027
Mailing Address - Country:US
Mailing Address - Phone:253-683-4277
Mailing Address - Fax:253-683-4278
Practice Address - Street 1:6615 6TH AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-2027
Practice Address - Country:US
Practice Address - Phone:253-683-4277
Practice Address - Fax:253-683-4278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-14
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034272111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty