Provider Demographics
NPI:1942496773
Name:BARRY A QUAM DC PS
Entity Type:Organization
Organization Name:BARRY A QUAM DC PS
Other - Org Name:QUAM CHIROPRACTIC CENTRE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:QUAM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:253-854-1233
Mailing Address - Street 1:25012 104TH AVE SE
Mailing Address - Street 2:SUITE E
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-2821
Mailing Address - Country:US
Mailing Address - Phone:253-854-1233
Mailing Address - Fax:253-854-1297
Practice Address - Street 1:25012 104TH AVE SE
Practice Address - Street 2:SUITE E
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-2821
Practice Address - Country:US
Practice Address - Phone:253-854-1233
Practice Address - Fax:253-854-1297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-14
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001274111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8803186Medicare PIN