Provider Demographics
NPI:1831373489
Name:AMERICAN CHIROPRACTIC CLINIC
Entity type:Organization
Organization Name:AMERICAN CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:TRAPANI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:509-525-0300
Mailing Address - Street 1:1618 E ISAACS AVE
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-2206
Mailing Address - Country:US
Mailing Address - Phone:509-525-0300
Mailing Address - Fax:509-525-2458
Practice Address - Street 1:1618 E ISAACS AVE
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-2206
Practice Address - Country:US
Practice Address - Phone:509-525-0300
Practice Address - Fax:509-525-2458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-18
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002084111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAB39427Medicare PIN
T02431Medicare UPIN