Healthcare Provider Details

I. General information

NPI: 1639440084
Provider Name (Legal Business Name): OLYMPIA CHIROPRACTIC CENTER PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2012
Last Update Date: 05/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2716 PACIFIC AVE SE SUITE A
OLYMPIA WA
98501-8804
US

IV. Provider business mailing address

2716 PACIFIC AVE SE SUITE A
OLYMPIA WA
98501-8804
US

V. Phone/Fax

Practice location:
  • Phone: 360-943-8250
  • Fax: 360-943-0473
Mailing address:
  • Phone: 360-943-8250
  • Fax: 360-943-0473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH60176120
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberCH1277
License Number StateWA

VIII. Authorized Official

Name: DR. KRISTOPHER WILLIAM ROYAL
Title or Position: PRESIDENT
Credential: DC
Phone: 360-943-8250