Basic Information
| Provider Information | |||||||||
| NPI: | 1578595179 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ACCIDENT & INJURY CHIROPRACTIC CENTER INC. | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1702 S 72ND ST | ||||||||
| Address2: | SUITE A | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984081238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2534740677 | ||||||||
| FaxNumber: | 2534743540 | ||||||||
| Practice Location | |||||||||
| Address1: | 1702 S 72ND ST | ||||||||
| Address2: | SUITE A | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984081238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2534740677 | ||||||||
| FaxNumber: | 2534743540 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2006 | ||||||||
| LastUpdateDate: | 02/14/2013 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | VRANNA | ||||||||
| AuthorizedOfficialFirstName: | JOEL | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2534740677 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | DC | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 602010653 | WA | Y | 193400000X SINGLE SPECIALTY GROUP | Chiropractic Providers | Chiropractor |
ID Information
| ID | Type | State | Issuer | Description | CK3813 | 01 | WA | RAILROAD MEDICARE | OTHER | 2010924 | 05 | WA | MEDICAID | 134324 | 01 | WA | STATE LABOR & INDUSTRIES | OTHER |