Provider Demographics
NPI:1679698278
Name:SUNSET CHIROPRACTIC & WELLNESS CENTER. INC
Entity Type:Organization
Organization Name:SUNSET CHIROPRACTIC & WELLNESS CENTER. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:253-891-9109
Mailing Address - Street 1:22015 HWY 410 E
Mailing Address - Street 2:
Mailing Address - City:BONNEY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98391
Mailing Address - Country:US
Mailing Address - Phone:253-891-9109
Mailing Address - Fax:
Practice Address - Street 1:22015 HWY 410 E
Practice Address - Street 2:
Practice Address - City:BONNEY LAKE
Practice Address - State:WA
Practice Address - Zip Code:98391
Practice Address - Country:US
Practice Address - Phone:253-891-9109
Practice Address - Fax:253-826-0438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
111N00000X
WACH00034433111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA99514OtherW.C. & L&I GRP NUMBER
WAU89992Medicare UPIN
WA99514OtherW.C. & L&I GRP NUMBER
WAG8853343Medicare PIN