Provider Demographics
NPI:1982825618
Name:SKAGIT RIVER CHIROPRACTIC PS INC
Entity Type:Organization
Organization Name:SKAGIT RIVER CHIROPRACTIC PS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:RONALD
Authorized Official - Last Name:KITZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-757-7373
Mailing Address - Street 1:830 E FAIRHAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98233-1917
Mailing Address - Country:US
Mailing Address - Phone:360-757-7373
Mailing Address - Fax:360-757-6369
Practice Address - Street 1:830 E FAIRHAVEN AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98233-1917
Practice Address - Country:US
Practice Address - Phone:360-757-7373
Practice Address - Fax:360-757-6369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA070238750111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty