Provider Demographics
NPI:1649220831
Name:GILLESPIE CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:GILLESPIE CHIROPRACTIC CLINIC
Other - Org Name:GILLESPIE FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:TIPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-835-9911
Mailing Address - Street 1:3307 EVERGREEN WAY
Mailing Address - Street 2:
Mailing Address - City:WASHOUGAL
Mailing Address - State:WA
Mailing Address - Zip Code:98671-2065
Mailing Address - Country:US
Mailing Address - Phone:360-835-9911
Mailing Address - Fax:360-835-5765
Practice Address - Street 1:3307 EVERGREEN WAY
Practice Address - Street 2:
Practice Address - City:WASHOUGAL
Practice Address - State:WA
Practice Address - Zip Code:98671-2062
Practice Address - Country:US
Practice Address - Phone:360-835-9911
Practice Address - Fax:360-835-5765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002513111N00000X
WACH00034407111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty