Provider Demographics
NPI:1619151131
Name:ELLENSBURG CHIROPRACTIC
Entity Type:Organization
Organization Name:ELLENSBURG CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING CLERK
Authorized Official - Prefix:MRS
Authorized Official - First Name:TANA
Authorized Official - Middle Name:
Authorized Official - Last Name:WORLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-962-2225
Mailing Address - Street 1:109 S WATER ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926-3061
Mailing Address - Country:US
Mailing Address - Phone:209-962-2225
Mailing Address - Fax:509-962-2270
Practice Address - Street 1:109 S WATER ST
Practice Address - Street 2:SUITE 2
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-3061
Practice Address - Country:US
Practice Address - Phone:209-962-2225
Practice Address - Fax:509-962-2270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-19
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty