Provider Demographics
NPI:1023208519
Name:COULEE CHIROPRACTIC, INC.
Entity type:Organization
Organization Name:COULEE CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TYRONE
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:TREXLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:509-632-8668
Mailing Address - Street 1:PO BOX 817
Mailing Address - Street 2:
Mailing Address - City:COULEE CITY
Mailing Address - State:WA
Mailing Address - Zip Code:99115-0817
Mailing Address - Country:US
Mailing Address - Phone:509-632-8668
Mailing Address - Fax:509-632-5761
Practice Address - Street 1:130 N ADAMS
Practice Address - Street 2:
Practice Address - City:COULEE CITY
Practice Address - State:WA
Practice Address - Zip Code:99115
Practice Address - Country:US
Practice Address - Phone:509-632-8668
Practice Address - Fax:509-632-5761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-31
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034180111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WADD9288OtherRAILROAD MEDICARE
WA30OtherL&I GROUP
WA30OtherL&I GROUP