Healthcare Provider Details

I. General information

NPI: 1912074501
Provider Name (Legal Business Name): CHIROPRACTIC ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 NW BUCKLIN HILL RD STE 101
SILVERDALE WA
98383-8359
US

IV. Provider business mailing address

3100 NW BUCKLIN HILL RD STE 101
SILVERDALE WA
98383-8359
US

V. Phone/Fax

Practice location:
  • Phone: 360-613-0430
  • Fax:
Mailing address:
  • Phone: 360-613-0430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH00034516
License Number StateWA

VIII. Authorized Official

Name: DR. TONY LANE
Title or Position: MEMBER
Credential:
Phone: 360-613-0430