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General NPI Number Information
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NPI Number | 1548433683
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Entity Type | Organization
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Legal Business Name | BAYSHORE CHIROPRACTIC, PS
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Dates
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Enumeration Date | 04/09/2008
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Last Update Date | 08/02/2011
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Provider Practice Location Address
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Address Line | 840 SE BAYSHORE DR STE 101
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City | OAK HARBOR
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State | WA
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Zip | 98277-4062
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Country | US
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Telephone | 360-675-1066
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Fax | 360-679-2278
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Provider Business Mailing Address
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Address Line | PO BOX 1706
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City | OAK HARBOR
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State | WA
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Zip | 98277-1706
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Country | US
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Telephone | 360-675-1066
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Fax | 360-679-2278
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. LILLIAN DAWN KEITH-MADEIROS
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Credential | D.C.
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Telephone | 360-675-1066
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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 | CH00003601
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License Number State | WA
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