Provider Demographics
NPI:1538170097
Name:GOLD BAR CHIROPRACTIC P.L.L.C
Entity type:Organization
Organization Name:GOLD BAR CHIROPRACTIC P.L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:ALLISON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-793-0904
Mailing Address - Street 1:301 CROFT AVE
Mailing Address - Street 2:PO BOX 175
Mailing Address - City:GOLD BAR
Mailing Address - State:WA
Mailing Address - Zip Code:98251-0175
Mailing Address - Country:US
Mailing Address - Phone:360-793-0904
Mailing Address - Fax:360-799-0923
Practice Address - Street 1:211 W. HILL STREET
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272
Practice Address - Country:US
Practice Address - Phone:360-793-0904
Practice Address - Fax:360-799-0923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00012526225700000X
WACH00033928111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty