Provider Demographics
NPI:1669645677
Name:CLEAR CHOICE CHIROPRACTIC PC, INC.
Entity Type:Organization
Organization Name:CLEAR CHOICE CHIROPRACTIC PC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:I
Authorized Official - Credentials:DC
Authorized Official - Phone:360-666-7722
Mailing Address - Street 1:15 SW 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-4371
Mailing Address - Country:US
Mailing Address - Phone:360-666-7722
Mailing Address - Fax:360-666-3388
Practice Address - Street 1:15 SW 12TH AVE
Practice Address - Street 2:
Practice Address - City:BATTLE GROUND
Practice Address - State:WA
Practice Address - Zip Code:98604-4371
Practice Address - Country:US
Practice Address - Phone:360-666-7722
Practice Address - Fax:360-666-3388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034124111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB32863Medicare UPIN