Provider Demographics
NPI:1548631393
Name:AKITA CHIROPRACTIC
Entity type:Organization
Organization Name:AKITA CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:AKITA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:541-296-1900
Mailing Address - Street 1:818 W 6TH ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058-1147
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:818 W 6TH ST
Practice Address - Street 2:SUITE 5
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-1147
Practice Address - Country:US
Practice Address - Phone:541-296-1900
Practice Address - Fax:541-298-7340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-19
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5080111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty