Basic Information
| Provider Information | |||||||||
| NPI: | 1396245635 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RAYMOND CHIROPRACTIC INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1702 S 72ND ST STE A | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984081238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2534740677 | ||||||||
| FaxNumber: | 2534743540 | ||||||||
| Practice Location | |||||||||
| Address1: | 1702 S 72ND ST STE A | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984081238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2534740677 | ||||||||
| FaxNumber: | 2534743540 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2018 | ||||||||
| LastUpdateDate: | 02/13/2018 | ||||||||
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| AuthorizedOfficialLastName: | SELBY | ||||||||
| AuthorizedOfficialFirstName: | VIRGINIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING ASSOCIATE | ||||||||
| AuthorizedOfficialTelephone: | 2534740677 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | CH00002175 | WA | Y | 193400000X SINGLE SPECIALTY GROUP | Chiropractic Providers | Chiropractor |
ID Information
| ID | Type | State | Issuer | Description | RA3981 | 01 | REGENCE | OTHER | 0032023 | 01 | WA | LABOR AND INDUSTRIES | OTHER |