Provider Demographics
NPI:1740376912
Name:COMMENCEMENT BAY CHIROPRACTIC PS
Entity type:Organization
Organization Name:COMMENCEMENT BAY CHIROPRACTIC PS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CALAH
Authorized Official - Middle Name:H
Authorized Official - Last Name:TENNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-379-0800
Mailing Address - Street 1:1233 LAWRENCE ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-6554
Mailing Address - Country:US
Mailing Address - Phone:360-379-0800
Mailing Address - Fax:360-379-0801
Practice Address - Street 1:1233 LAWRENCE ST
Practice Address - Street 2:SUITE 201
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-6554
Practice Address - Country:US
Practice Address - Phone:360-379-0800
Practice Address - Fax:360-379-0801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034436111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0225176OtherL&I GROUP
WA0225176OtherL&I GROUP
WAG8863034Medicare PIN