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General NPI Number Information
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NPI Number | 1881964419
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Entity Type | Organization
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Legal Business Name | EAGLE HARBOR HEALTH & CHIROPRACTIC
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Dates
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Enumeration Date | 01/12/2012
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Last Update Date | 07/11/2025
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Provider Practice Location Address
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Address Line | 2405 EVERGREEN PARK DR SW STE B1
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City | OLYMPIA
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State | WA
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Zip | 98502-6000
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Country | US
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Telephone | 206-842-2690
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Fax |
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Provider Business Mailing Address
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Address Line | 3212 RED FERN DR NW
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City | OLYMPIA
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State | WA
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Zip | 98502-3224
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Country | US
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Telephone | 206-842-2690
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KIRK WILLIAM PETHERAM
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Credential | D.C.
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Telephone | 206-842-2702
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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 | CH00003554
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License Number State | WA
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