Provider Demographics
NPI:1801039185
Name:BURLINGTON CHIROPRACTIC CLINIC, INC. PS
Entity Type:Organization
Organization Name:BURLINGTON CHIROPRACTIC CLINIC, INC. PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:GEAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-755-1414
Mailing Address - Street 1:249 S BURLINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98233-1708
Mailing Address - Country:US
Mailing Address - Phone:360-755-1414
Mailing Address - Fax:360-755-0172
Practice Address - Street 1:249 S BURLINGTON BLVD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98233-1708
Practice Address - Country:US
Practice Address - Phone:360-755-1414
Practice Address - Fax:360-755-0172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-15
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3117111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG115000522Medicare PIN