Provider Demographics
NPI:1669756094
Name:BACK IN ACTION CHIROPRACTIC
Entity type:Organization
Organization Name:BACK IN ACTION CHIROPRACTIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KARIN
Authorized Official - Middle Name:LAIMER
Authorized Official - Last Name:NOSRATI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-254-1585
Mailing Address - Street 1:20107 NE 14TH ST
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-7667
Mailing Address - Country:US
Mailing Address - Phone:360-254-1585
Mailing Address - Fax:360-254-1210
Practice Address - Street 1:20107 NE 14TH ST
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-7667
Practice Address - Country:US
Practice Address - Phone:360-254-1585
Practice Address - Fax:360-254-1210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002905111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0037434OtherWA DEPARTMENT OF LABOR AND INDUSTRIES
WACH00002905OtherWASHINGTON STATE DEPARTMENT OF HEALTH
WAU47153Medicare UPIN