Provider Demographics
NPI:1972662377
Name:GAITLINK CHIROPRACTIC CENTER INC
Entity Type:Organization
Organization Name:GAITLINK CHIROPRACTIC CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHESTER
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:SWANSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-297-4544
Mailing Address - Street 1:PO BOX 267
Mailing Address - Street 2:
Mailing Address - City:PORT GAMBLE
Mailing Address - State:WA
Mailing Address - Zip Code:98364-0267
Mailing Address - Country:US
Mailing Address - Phone:360-297-4544
Mailing Address - Fax:360-297-7657
Practice Address - Street 1:10978 STATE HWY 104
Practice Address - Street 2:SUITE 125
Practice Address - City:KINGSTON
Practice Address - State:WA
Practice Address - Zip Code:98346
Practice Address - Country:US
Practice Address - Phone:360-297-4544
Practice Address - Fax:360-297-7657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002128111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty