Provider Demographics
NPI:1265101323
Name:BRENT A LINSE PS
Entity type:Organization
Organization Name:BRENT A LINSE PS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:A
Authorized Official - Last Name:LINSE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:253-537-8181
Mailing Address - Street 1:PO BOX 146
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-0015
Mailing Address - Country:US
Mailing Address - Phone:253-732-7224
Mailing Address - Fax:
Practice Address - Street 1:5216 72ND ST E
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98443-2722
Practice Address - Country:US
Practice Address - Phone:253-537-8181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRENT A LINSE PS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-09-10
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1155799OtherREGENCE ID