Provider Demographics
NPI:1295855567
Name:NORTHWEST CHIROPRACTIC, INC.
Entity type:Organization
Organization Name:NORTHWEST CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LORRI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:253-927-0660
Mailing Address - Street 1:34730 PACIFIC HWY S
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6821
Mailing Address - Country:US
Mailing Address - Phone:253-927-0660
Mailing Address - Fax:253-874-0408
Practice Address - Street 1:34730 PACIFIC HWY S
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6821
Practice Address - Country:US
Practice Address - Phone:253-927-0660
Practice Address - Fax:253-874-0408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225700000X
WACH00001902111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0073361OtherLABOR & INDUSTRIES
WA0073361OtherLABOR & INDUSTRIES
WAU21207Medicare UPIN