Provider Demographics
NPI:1790991735
Name:FEATHERSTONE CHIROPRACTIC CLINIC, PLLC
Entity Type:Organization
Organization Name:FEATHERSTONE CHIROPRACTIC CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:FEATHERSTONE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-256-5253
Mailing Address - Street 1:12116 SE MILL PLAIN BLVD
Mailing Address - Street 2:#2
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-6000
Mailing Address - Country:US
Mailing Address - Phone:360-256-5253
Mailing Address - Fax:360-256-5081
Practice Address - Street 1:12116 SE MILL PLAIN BLVD
Practice Address - Street 2:#2
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-6000
Practice Address - Country:US
Practice Address - Phone:360-256-5253
Practice Address - Fax:360-256-5081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2289111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAT91751Medicare UPIN
WA00615477Medicare ID - Type Unspecified