Provider Demographics
NPI:1831122373
Name:RAINIER CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:RAINIER CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CHIROPRACTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:DISPENZA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-400-3151
Mailing Address - Street 1:PO BOX 656
Mailing Address - Street 2:
Mailing Address - City:RAINIER
Mailing Address - State:WA
Mailing Address - Zip Code:98576-0656
Mailing Address - Country:US
Mailing Address - Phone:360-400-3151
Mailing Address - Fax:360-400-3150
Practice Address - Street 1:503 1ST ST S
Practice Address - Street 2:
Practice Address - City:YELM
Practice Address - State:WA
Practice Address - Zip Code:98597-7634
Practice Address - Country:US
Practice Address - Phone:360-400-3151
Practice Address - Fax:360-400-3150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2011-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA601290297000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0173734OtherL AND I CLINIC NUMBER
WA0173734OtherL AND I CLINIC NUMBER
WAT18448Medicare UPIN