Healthcare Provider Details

I. General information

NPI: 1114353711
Provider Name (Legal Business Name): WALLA WALLA CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2013
Last Update Date: 09/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 E BIRCH ST STE 12
WALLA WALLA WA
99362-3054
US

IV. Provider business mailing address

120 E BIRCH ST STE 12
WALLA WALLA WA
99362-3054
US

V. Phone/Fax

Practice location:
  • Phone: 509-522-2202
  • Fax: 509-527-4446
Mailing address:
  • Phone: 509-522-2202
  • Fax: 509-527-4446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH 00034403
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA 60126516
License Number StateWA

VIII. Authorized Official

Name: CHRISTOPHER R BESS
Title or Position: OWNER
Credential: D.C.
Phone: 509-522-2202