Provider Demographics
NPI:1629338017
Name:BELLINGHAM PERFORMANCE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:BELLINGHAM PERFORMANCE CHIROPRACTIC LLC
Other - Org Name:PERFORMANCE CHIROPRACTIC BELLINGHAM LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:DEROCHE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, DC, CSCS
Authorized Official - Phone:360-738-8877
Mailing Address - Street 1:3410 WOBURN ST SUITE 202
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-5621
Mailing Address - Country:US
Mailing Address - Phone:360-738-8877
Mailing Address - Fax:360-752-3199
Practice Address - Street 1:3410 WOBURN ST STE 202
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-5621
Practice Address - Country:US
Practice Address - Phone:360-738-8877
Practice Address - Fax:360-752-3199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH 00034787111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA166674873OtherNPI