Provider Demographics
NPI:1467652925
Name:PREMIER CHIROPRACTIC
Entity type:Organization
Organization Name:PREMIER CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:J
Authorized Official - Last Name:IGIELSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:206-431-1111
Mailing Address - Street 1:14245 AMBAUM BLVD SW
Mailing Address - Street 2:F
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-1421
Mailing Address - Country:US
Mailing Address - Phone:206-431-1111
Mailing Address - Fax:206-242-3141
Practice Address - Street 1:14245 AMBAUM BLVD SW
Practice Address - Street 2:F
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-1421
Practice Address - Country:US
Practice Address - Phone:206-431-1111
Practice Address - Fax:206-242-3141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH2156111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty