Provider Demographics
NPI:1942309687
Name:CHAMPION, JOHN ROBERT (DC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ROBERT
Last Name:CHAMPION
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 203
Mailing Address - Street 2:
Mailing Address - City:VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99181-0203
Mailing Address - Country:US
Mailing Address - Phone:509-935-2225
Mailing Address - Fax:509-935-2273
Practice Address - Street 1:103 E MAIN AVE
Practice Address - Street 2:
Practice Address - City:CHEWELAH
Practice Address - State:WA
Practice Address - Zip Code:99109-8960
Practice Address - Country:US
Practice Address - Phone:509-935-2225
Practice Address - Fax:509-935-2273
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00033990111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8802891Medicare ID - Type UnspecifiedCHIROPRACTOR