Provider Demographics
NPI:1962684803
Name:GEORGE ELMENHURST DC PS
Entity Type:Organization
Organization Name:GEORGE ELMENHURST DC PS
Other - Org Name:ELMENHURST CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:A
Authorized Official - Last Name:ELMENHURST
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:509-525-4160
Mailing Address - Street 1:903 S HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-3326
Mailing Address - Country:US
Mailing Address - Phone:509-525-4160
Mailing Address - Fax:509-522-9921
Practice Address - Street 1:903 S HOWARD ST
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-3326
Practice Address - Country:US
Practice Address - Phone:509-525-4160
Practice Address - Fax:509-522-9921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH000 02843111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAW92828Medicare UPIN