Provider Demographics
NPI:1609045004
Name:DYNAMIC CHIROPRACTIC CLINIC, PS
Entity Type:Organization
Organization Name:DYNAMIC CHIROPRACTIC CLINIC, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:CARR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:206-343-3325
Mailing Address - Street 1:17511 68TH AVE NE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:KENMORE
Mailing Address - State:WA
Mailing Address - Zip Code:98028
Mailing Address - Country:US
Mailing Address - Phone:206-343-3325
Mailing Address - Fax:206-838-7330
Practice Address - Street 1:17511 68TH AVE NE
Practice Address - Street 2:SUITE 1
Practice Address - City:KENMORE
Practice Address - State:WA
Practice Address - Zip Code:98028
Practice Address - Country:US
Practice Address - Phone:206-343-3325
Practice Address - Fax:206-838-7330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-29
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH33993111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty