Provider Demographics
NPI:1831306331
Name:ISLAND CHIROPRACTIC PS INC
Entity Type:Organization
Organization Name:ISLAND CHIROPRACTIC PS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC MEDICINE
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:WASSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-675-4954
Mailing Address - Street 1:551 SE MAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-5000
Mailing Address - Country:US
Mailing Address - Phone:360-675-4954
Mailing Address - Fax:360-675-4968
Practice Address - Street 1:551 SE MAYLOR ST
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-5000
Practice Address - Country:US
Practice Address - Phone:360-675-4954
Practice Address - Fax:360-675-4968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA6015169250010001111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty