Provider Demographics
NPI:1669775961
Name:WHATCOM CHIROPRACTIC CENTER PS
Entity type:Organization
Organization Name:WHATCOM CHIROPRACTIC CENTER PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:HODGE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-671-6867
Mailing Address - Street 1:PO BOX 31847
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98228-3847
Mailing Address - Country:US
Mailing Address - Phone:360-671-6867
Mailing Address - Fax:360-671-6877
Practice Address - Street 1:4097 JAMES ST RD
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226
Practice Address - Country:US
Practice Address - Phone:360-671-6867
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-09
Last Update Date:2011-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002706111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB23153Medicare PIN