Provider Demographics
NPI:1669517553
Name:PROCTOR CHIROPRACTIC INC. PS
Entity type:Organization
Organization Name:PROCTOR CHIROPRACTIC INC. PS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:KEOGH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:253-756-7500
Mailing Address - Street 1:3901 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-4940
Mailing Address - Country:US
Mailing Address - Phone:253-756-7500
Mailing Address - Fax:253-756-7501
Practice Address - Street 1:3901 6TH AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-4940
Practice Address - Country:US
Practice Address - Phone:253-756-7500
Practice Address - Fax:253-756-7501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00033867111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8867901Medicare PIN