Provider Demographics
NPI:1831206911
Name:COMMUNITY CHIROPRACTIC PS
Entity type:Organization
Organization Name:COMMUNITY CHIROPRACTIC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GWENDOLYN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SCHAUER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-705-1116
Mailing Address - Street 1:3525 ENSIGN RD NE STE G
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5065
Mailing Address - Country:US
Mailing Address - Phone:360-705-1116
Mailing Address - Fax:360-236-0535
Practice Address - Street 1:2968 LIMITED LANE NW
Practice Address - Street 2:SUITE A
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502
Practice Address - Country:US
Practice Address - Phone:360-705-1116
Practice Address - Fax:360-236-0535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2556111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2021871Medicaid
WAU23803Medicare UPIN
AB18544Medicare ID - Type Unspecified