Provider Demographics
NPI:1952448896
Name:CONSTANTIN CHIROPRACTIC CLINIC PC
Entity Type:Organization
Organization Name:CONSTANTIN CHIROPRACTIC CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PIERRE
Authorized Official - Middle Name:R
Authorized Official - Last Name:CONSTANTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-384-4611
Mailing Address - Street 1:PO BOX 1992
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98248-1992
Mailing Address - Country:US
Mailing Address - Phone:360-384-4611
Mailing Address - Fax:360-384-2574
Practice Address - Street 1:2017 MAIN ST
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:WA
Practice Address - Zip Code:98248-1992
Practice Address - Country:US
Practice Address - Phone:360-384-4611
Practice Address - Fax:360-384-2574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001782111N00000X
WACH00002045111N00000X
WACH00034646111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2091205Medicaid
T83843Medicare UPIN
WAAB18033Medicare ID - Type Unspecified