Provider Demographics
NPI:1770664187
Name:BROADWAY FAMILY CHIROPRACTIC INC
Entity Type:Organization
Organization Name:BROADWAY FAMILY CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:BLANCHE
Authorized Official - Last Name:MURRY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-734-9525
Mailing Address - Street 1:PO BOX 1215
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98227-1215
Mailing Address - Country:US
Mailing Address - Phone:360-734-9525
Mailing Address - Fax:360-734-9505
Practice Address - Street 1:1810 BROADWAY
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-3133
Practice Address - Country:US
Practice Address - Phone:360-734-9525
Practice Address - Fax:360-734-9505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00033920111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty