Provider Demographics
NPI:1457369449
Name:CROSS CHIROPRACTIC PS
Entity Type:Organization
Organization Name:CROSS CHIROPRACTIC PS
Other - Org Name:NANCY F CROSS DC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:FAYE
Authorized Official - Last Name:CROSS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-832-3117
Mailing Address - Street 1:PO BOX 657
Mailing Address - Street 2:
Mailing Address - City:EATONVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98328-0657
Mailing Address - Country:US
Mailing Address - Phone:360-832-3117
Mailing Address - Fax:360-832-4815
Practice Address - Street 1:47207 138TH AVE E
Practice Address - Street 2:
Practice Address - City:EATONVILLE
Practice Address - State:WA
Practice Address - Zip Code:98328
Practice Address - Country:US
Practice Address - Phone:360-832-3117
Practice Address - Fax:360-832-4815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH3549111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA120012143211OtherLABOR & INDUSTRIES
WAAB14111Medicare ID - Type Unspecified