Provider Demographics
NPI:1629232053
Name:DR. LINDA JEAN DEGROOT P.S.C.
Entity Type:Organization
Organization Name:DR. LINDA JEAN DEGROOT P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:DEGROOT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:253-854-7711
Mailing Address - Street 1:20536 108TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98031-1542
Mailing Address - Country:US
Mailing Address - Phone:253-854-7711
Mailing Address - Fax:253-859-4792
Practice Address - Street 1:20536 108TH AVE SE
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98031-1542
Practice Address - Country:US
Practice Address - Phone:253-854-7711
Practice Address - Fax:253-859-4792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002149111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG000106938Medicare PIN