Healthcare Provider Details

I. General information

NPI: 1972556439
Provider Name (Legal Business Name): INTER ISLAND CHIROPRACTIC INC PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 08/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 N BEACH RD
EASTSOUND WA
98245-8927
US

IV. Provider business mailing address

PO BOX 955
EASTSOUND WA
98245-0955
US

V. Phone/Fax

Practice location:
  • Phone: 360-376-2100
  • Fax: 360-376-6255
Mailing address:
  • Phone: 360-376-2100
  • Fax: 360-376-6255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number602 585 485
License Number StateWA

VIII. Authorized Official

Name: JOHN W FABIANEK
Title or Position: PROPRIETOR
Credential: D.C.
Phone: 360-376-2100