Provider Demographics
NPI:1780851477
Name:BOTHELL CHIROPRACTIC & WELLNESS, PLLC
Entity Type:Organization
Organization Name:BOTHELL CHIROPRACTIC & WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DUSTY
Authorized Official - Middle Name:D
Authorized Official - Last Name:DUBOIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:425-485-1413
Mailing Address - Street 1:PO BOX 1286
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98041-1286
Mailing Address - Country:US
Mailing Address - Phone:425-485-1413
Mailing Address - Fax:
Practice Address - Street 1:10024 MAIN ST
Practice Address - Street 2:SUITE 2-C
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-3424
Practice Address - Country:US
Practice Address - Phone:425-485-1413
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-12
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3632261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1235137639OtherINDIVIDUAL NPI NUMBER
WA350056758OtherRR MEDICARE
AB10961OtherMEDICARE
WA125930OtherL&I PROVIDER NUMBER
WA1235137639OtherINDIVIDUAL NPI NUMBER