Provider Demographics
NPI:1700090362
Name:CHIROPRACTIC LIFECENTER, INC.
Entity Type:Organization
Organization Name:CHIROPRACTIC LIFECENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:DOUGHERTY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:509-844-4206
Mailing Address - Street 1:2319 W MAXWELL AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-2916
Mailing Address - Country:US
Mailing Address - Phone:509-844-4206
Mailing Address - Fax:
Practice Address - Street 1:1609 W GARLAND AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-2620
Practice Address - Country:US
Practice Address - Phone:509-327-3393
Practice Address - Fax:509-324-9164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034440111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA192951OtherLABOR & INDUSTRY
WA8851604Medicare PIN
WA8851605Medicare PIN
WA192951OtherLABOR & INDUSTRY
WAU86141Medicare UPIN