Provider Demographics
NPI:1689728610
Name:NORTHWEST FAMILY CHIROPRACTIC PC
Entity Type:Organization
Organization Name:NORTHWEST FAMILY CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:253-848-6603
Mailing Address - Street 1:17615 85TH AVENUE CT E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375-1859
Mailing Address - Country:US
Mailing Address - Phone:253-848-6603
Mailing Address - Fax:253-445-9430
Practice Address - Street 1:17615 85TH AVENUE CT E
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98375-1859
Practice Address - Country:US
Practice Address - Phone:253-848-6603
Practice Address - Fax:253-445-9430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2705111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA601879408OtherWA UBI#
WA2705OtherWA CHIRO LICENSE
WAH04731OtherREGENCE
WALNIOtherLNI PROVIDER #
WA350050140OtherRAILROAD MEDICARE
WA8803451Medicare ID - Type UnspecifiedINDIVIDUAL PROV #