Provider Demographics
NPI:1922437151
Name:LA CONNER CHIROPRACTIC
Entity Type:Organization
Organization Name:LA CONNER CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:WAWRZYNIEC
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-840-5111
Mailing Address - Street 1:2111 11TH ST
Mailing Address - Street 2:
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-1431
Mailing Address - Country:US
Mailing Address - Phone:360-840-5111
Mailing Address - Fax:
Practice Address - Street 1:2111 11TH ST
Practice Address - Street 2:
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-1431
Practice Address - Country:US
Practice Address - Phone:360-840-5111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60404596111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty