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General NPI Number Information
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NPI Number | 1992150346
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Entity Type | Organization
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Legal Business Name | FERNDALE CHIROPRACTIC CLINIC LLC
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Dates
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Enumeration Date | 05/03/2016
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Last Update Date | 07/10/2019
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Provider Practice Location Address
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Address Line | 2376 MAIN ST STE 1
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City | FERNDALE
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State | WA
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Zip | 98248-8605
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Country | US
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Telephone | 360-312-4656
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Fax | 360-392-8732
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Provider Business Mailing Address
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Address Line | PO BOX 1256
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City | FERNDALE
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State | WA
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Zip | 98248-1256
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Country | US
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Telephone | 360-312-4656
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Fax | 360-392-8732
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Authorized Official
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Title or Position | OWNER
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Name | PIERRE R CONSTANTIN
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Credential | DC
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Telephone | 360-319-3485
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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 | CH0001782
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License Number State | WA
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