Provider Demographics
NPI:1730484700
Name:CK CHIROPRACTIC
Entity Type:Organization
Organization Name:CK CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWENER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:FROINES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-692-0181
Mailing Address - Street 1:2851 NW KITSAP PL
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-9447
Mailing Address - Country:US
Mailing Address - Phone:360-692-0181
Mailing Address - Fax:360-692-3847
Practice Address - Street 1:2851 NW KITSAP PL
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-9447
Practice Address - Country:US
Practice Address - Phone:360-692-0181
Practice Address - Fax:360-692-3847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-21
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002049111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA60271522OtherUBI
WAAB 18438Medicare PIN
WA60271522OtherUBI