Provider Demographics
NPI:1336270586
Name:STRAIGHT CHIROPRACTIC INCORPORATED
Entity Type:Organization
Organization Name:STRAIGHT CHIROPRACTIC INCORPORATED
Other - Org Name:SNO-VALLEY FAMILY CHIROPRACTIC CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:MASSENGILL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:425-888-4170
Mailing Address - Street 1:PO BOX 1056
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:WA
Mailing Address - Zip Code:98045-1056
Mailing Address - Country:US
Mailing Address - Phone:425-888-4170
Mailing Address - Fax:425-888-6431
Practice Address - Street 1:318 E PARK ST
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:WA
Practice Address - Zip Code:98045-8200
Practice Address - Country:US
Practice Address - Phone:425-888-4170
Practice Address - Fax:425-888-6431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8802969Medicare PIN