Provider Demographics
NPI:1023407343
Name:INTEGRATED CHIROPRACTIC
Entity type:Organization
Organization Name:INTEGRATED CHIROPRACTIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-516-6296
Mailing Address - Street 1:9220 RIDGETOP BLVD.
Mailing Address - Street 2:STE 100
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-8556
Mailing Address - Country:US
Mailing Address - Phone:360-516-6296
Mailing Address - Fax:360-308-0937
Practice Address - Street 1:9220 RIDGETOP BLVD.
Practice Address - Street 2:STE 100
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8556
Practice Address - Country:US
Practice Address - Phone:360-516-6296
Practice Address - Fax:360-308-0937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-12
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH 60153099261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8897141Medicare UPIN