Provider Demographics
NPI:1629123237
Name:ALLIED CHIROPRACTIC PAIN & INJURY CENTER
Entity Type:Organization
Organization Name:ALLIED CHIROPRACTIC PAIN & INJURY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERRILYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:NICKLIN-GRISWOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-434-3009
Mailing Address - Street 1:PO BOX 11810
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-5810
Mailing Address - Country:US
Mailing Address - Phone:360-434-3009
Mailing Address - Fax:360-895-5380
Practice Address - Street 1:804 CALLAHAN DR # B
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-3307
Practice Address - Country:US
Practice Address - Phone:360-373-5400
Practice Address - Fax:360-373-5401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034243111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA3714AFOtherREGENCE PIN
WA0170690OtherL&I PIN
WA0170690OtherL&I PIN