Provider Demographics
NPI:1942473673
Name:AUSTIN CHIROPRACTIC, INC PS
Entity Type:Organization
Organization Name:AUSTIN CHIROPRACTIC, INC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-671-5263
Mailing Address - Street 1:1800 JAMES ST STE 102
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-4631
Mailing Address - Country:US
Mailing Address - Phone:360-671-5263
Mailing Address - Fax:360-671-3407
Practice Address - Street 1:1800 JAMES ST STE 102
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4631
Practice Address - Country:US
Practice Address - Phone:360-671-5263
Practice Address - Fax:360-671-3407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2950111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB15926Medicare PIN