Provider Demographics
NPI:1205971835
Name:METCALF CHIROPRACTIC HEALTH CENTER, INC
Entity type:Organization
Organization Name:METCALF CHIROPRACTIC HEALTH CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:METCALF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:425-844-6428
Mailing Address - Street 1:PO BOX 507
Mailing Address - Street 2:
Mailing Address - City:DUVALL
Mailing Address - State:WA
Mailing Address - Zip Code:98019-0507
Mailing Address - Country:US
Mailing Address - Phone:425-844-6428
Mailing Address - Fax:425-788-7824
Practice Address - Street 1:15435 MAIN ST NE
Practice Address - Street 2:SUITE 101
Practice Address - City:DUVALL
Practice Address - State:WA
Practice Address - Zip Code:98019-8576
Practice Address - Country:US
Practice Address - Phone:425-844-6428
Practice Address - Fax:425-788-7824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00033861111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA128018128020OtherINSURANCE
WA53-1130544OtherREGENCE
WA531130544 5311MEOtherPREMERA
WA531130544OtherINSURANCE
WA2947555OtherL&I
WAGAB15230Medicare ID - Type Unspecified