Provider Demographics
NPI:1770643991
Name:HILL, JOHN WADE (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WADE
Last Name:HILL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7530 PMB 56
Mailing Address - Street 2:
Mailing Address - City:YELM
Mailing Address - State:WA
Mailing Address - Zip Code:98597-7530
Mailing Address - Country:US
Mailing Address - Phone:360-832-2167
Mailing Address - Fax:360-832-3661
Practice Address - Street 1:207 CENTER ST
Practice Address - Street 2:
Practice Address - City:EATONVILLE
Practice Address - State:WA
Practice Address - Zip Code:98328
Practice Address - Country:US
Practice Address - Phone:360-832-2167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003054111NI0900X, 111NN0400X, 111NN1001X, 111NR0400X, 111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111NI0900XChiropractic ProvidersChiropractorInternist
Not Answered111NN0400XChiropractic ProvidersChiropractorNeurology
Not Answered111NN1001XChiropractic ProvidersChiropractorNutrition
Not Answered111NR0400XChiropractic ProvidersChiropractorRehabilitation
Not Answered111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAU57238Medicare UPIN