Provider Demographics
NPI:1790825198
Name:VERHUNCE CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:VERHUNCE CHIROPRACTIC CORPORATION
Other - Org Name:VITALITY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:VERHUNCE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:206-824-5521
Mailing Address - Street 1:21904 MARINE VIEW DR S
Mailing Address - Street 2:SUITE C
Mailing Address - City:DES MOINES
Mailing Address - State:WA
Mailing Address - Zip Code:98198-6103
Mailing Address - Country:US
Mailing Address - Phone:206-824-5521
Mailing Address - Fax:206-212-7455
Practice Address - Street 1:21904 MARINE VIEW DR S
Practice Address - Street 2:SUITE C
Practice Address - City:DES MOINES
Practice Address - State:WA
Practice Address - Zip Code:98198-6103
Practice Address - Country:US
Practice Address - Phone:206-824-5521
Practice Address - Fax:206-212-7455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602003024111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0718VEOtherREGENCE RIDER NUMBER
WA0134456OtherDEPARTMENT OF LABOR & IND
WA2029312Medicaid
WA0134456OtherDEPARTMENT OF LABOR & IND
WA2029312Medicaid