Provider Demographics
NPI:1699199109
Name:BEACON CHIROPRACTIC CO
Entity Type:Organization
Organization Name:BEACON CHIROPRACTIC CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ISAAC
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-326-3396
Mailing Address - Street 1:11500 NE 119TH ST STE 104
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-1643
Mailing Address - Country:US
Mailing Address - Phone:360-326-3396
Mailing Address - Fax:360-369-0015
Practice Address - Street 1:11500 NE 119TH ST STE 104
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-1643
Practice Address - Country:US
Practice Address - Phone:360-326-3396
Practice Address - Fax:360-369-0015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-05
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty