Provider Demographics
NPI:1811149446
Name:NORTHWEST SPINE AND DISC CENTER INC.
Entity type:Organization
Organization Name:NORTHWEST SPINE AND DISC CENTER INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:DYCHES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-527-9828
Mailing Address - Street 1:1800 JAMES ST
Mailing Address - Street 2:#102
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-4631
Mailing Address - Country:US
Mailing Address - Phone:360-527-9828
Mailing Address - Fax:
Practice Address - Street 1:1800 JAMES ST
Practice Address - Street 2:#102
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4631
Practice Address - Country:US
Practice Address - Phone:360-527-9828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-14
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034223111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty