Provider Demographics
NPI:1881964419
Name:EAGLE HARBOR HEALTH & CHIROPRACTIC
Entity type:Organization
Organization Name:EAGLE HARBOR HEALTH & CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:PETHERAM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:206-842-2702
Mailing Address - Street 1:931 HILDEBRAND LN NE # 101
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-2823
Mailing Address - Country:US
Mailing Address - Phone:206-842-2690
Mailing Address - Fax:206-842-2847
Practice Address - Street 1:931 HILDEBRAND LN NE # 101A
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-2823
Practice Address - Country:US
Practice Address - Phone:120-684-2269
Practice Address - Fax:206-842-2847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-12
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003554111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty