Provider Demographics
NPI:1982866604
Name:SUNNYSIDE CHIROPRACTIC CENTRE P S
Entity Type:Organization
Organization Name:SUNNYSIDE CHIROPRACTIC CENTRE P S
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JORY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:509-839-5555
Mailing Address - Street 1:823 E LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:WA
Mailing Address - Zip Code:98944-2347
Mailing Address - Country:US
Mailing Address - Phone:509-839-5555
Mailing Address - Fax:509-839-9875
Practice Address - Street 1:823 E LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:WA
Practice Address - Zip Code:98944-2347
Practice Address - Country:US
Practice Address - Phone:509-839-5555
Practice Address - Fax:509-839-9875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034054111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U88196Medicare UPIN
WA8858539Medicare PIN