Provider Demographics
NPI:1598846040
Name:THE CHIROPRACTORS CLINIC, P.S.
Entity Type:Organization
Organization Name:THE CHIROPRACTORS CLINIC, P.S.
Other - Org Name:SILVERDALE CHIROPRACTIC CLINIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:STEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-698-3140
Mailing Address - Street 1:PO BOX 483
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383
Mailing Address - Country:US
Mailing Address - Phone:360-698-3140
Mailing Address - Fax:360-692-1441
Practice Address - Street 1:3595 NW BUCKIN HILL RD
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8503
Practice Address - Country:US
Practice Address - Phone:360-698-3140
Practice Address - Fax:360-692-1441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001522111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA192005900OtherOWCP
WA54151OtherLTI
WA=========OtherKPS
WA203760203760OtherPREMERA BLUE CROSS
WA203760203760OtherPREMERA BLUE CROSS
T02210Medicare UPIN