Provider Demographics
NPI:1639507908
Name:PROSSER CHIROPRACTIC & WELLNESS
Entity Type:Organization
Organization Name:PROSSER CHIROPRACTIC & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:GIBB
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:509-781-6235
Mailing Address - Street 1:354 CHARDONNAY AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PROSSER
Mailing Address - State:WA
Mailing Address - Zip Code:99350-9515
Mailing Address - Country:US
Mailing Address - Phone:509-781-6235
Mailing Address - Fax:
Practice Address - Street 1:354 CHARDONNAY AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:PROSSER
Practice Address - State:WA
Practice Address - Zip Code:99350-9515
Practice Address - Country:US
Practice Address - Phone:509-781-6235
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-24
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002652111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty