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General NPI Number Information
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NPI Number | 1326312935
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Entity Type | Organization
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Legal Business Name | HARDESTY CHIROPRACTIC, PS
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Dates
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Enumeration Date | 02/29/2012
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Last Update Date | 02/29/2012
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Provider Practice Location Address
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Address Line | 6031 47TH AVE NE SUITE B
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City | MARYSVILLE
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State | WA
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Zip | 98270-5168
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Country | US
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Telephone | 360-653-2312
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Fax | 360-653-7055
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Provider Business Mailing Address
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Address Line | PO BOX 295
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City | MARYSVILLE
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State | WA
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Zip | 98270-0295
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Country | US
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Telephone | 360-653-2312
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Fax | 360-653-9055
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Authorized Official
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Title or Position | PRES
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Name | DR. BRIAN E HARDESTY
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Credential | D.C.
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Telephone | 360-653-2312
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 1967
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License Number State | WA
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