Provider Demographics
NPI:1134792336
Name:ENUMCLAW FAMILY CHIROPRACTIC PLLC
Entity type:Organization
Organization Name:ENUMCLAW FAMILY CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:HENKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-653-1858
Mailing Address - Street 1:1624 PIONEER ST STE A
Mailing Address - Street 2:
Mailing Address - City:ENUMCLAW
Mailing Address - State:WA
Mailing Address - Zip Code:98022-2299
Mailing Address - Country:US
Mailing Address - Phone:360-825-5757
Mailing Address - Fax:
Practice Address - Street 1:1624 PIONEER ST STE A
Practice Address - Street 2:
Practice Address - City:ENUMCLAW
Practice Address - State:WA
Practice Address - Zip Code:98022-2299
Practice Address - Country:US
Practice Address - Phone:360-825-5757
Practice Address - Fax:360-825-5784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-23
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty