Provider Demographics
NPI:1871691022
Name:AKRIDGE CHIROPRACTIC INC, P.S.
Entity Type:Organization
Organization Name:AKRIDGE CHIROPRACTIC INC, P.S.
Other - Org Name:AKRIDGE CHIROPRACTIC LASER PAIN CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:KELLY
Authorized Official - Last Name:AKRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:509-783-8145
Mailing Address - Street 1:8511 W CLEARWATER AVE STE B
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-9592
Mailing Address - Country:US
Mailing Address - Phone:509-783-8145
Mailing Address - Fax:509-783-8147
Practice Address - Street 1:8511 W CLEARWATER AVE STE B
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-9592
Practice Address - Country:US
Practice Address - Phone:509-783-8145
Practice Address - Fax:509-783-8147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001581111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G8914971Medicare UPIN
000300021Medicare UPIN