Provider Demographics
NPI:1245377241
Name:MERIDIAN VALLEY CHIROPRACTIC CLINIC, PS
Entity type:Organization
Organization Name:MERIDIAN VALLEY CHIROPRACTIC CLINIC, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RITA
Authorized Official - Middle Name:A
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:253-631-1118
Mailing Address - Street 1:13210 SE 240TH ST
Mailing Address - Street 2:SUITE A-4
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98042-5182
Mailing Address - Country:US
Mailing Address - Phone:253-631-1118
Mailing Address - Fax:253-631-1156
Practice Address - Street 1:13210 SE 240TH ST
Practice Address - Street 2:SUITE A-4
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98042-5182
Practice Address - Country:US
Practice Address - Phone:253-631-1118
Practice Address - Fax:253-631-1156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002375111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8869947Medicare PIN
WA000167000Medicare ID - Type Unspecified