Provider Demographics
NPI:1043392533
Name:STRAIT CHIROPRACTIC P S
Entity type:Organization
Organization Name:STRAIT CHIROPRACTIC P S
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:GAUTHUN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-681-4322
Mailing Address - Street 1:PO BOX 2401
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-2401
Mailing Address - Country:US
Mailing Address - Phone:360-681-4322
Mailing Address - Fax:360-683-5569
Practice Address - Street 1:20 LEE CHATFIELD AVE.
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382
Practice Address - Country:US
Practice Address - Phone:360-681-4322
Practice Address - Fax:360-683-5569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2923111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA37037OtherL&I
WAU47147Medicare UPIN
WAG8869714Medicare PIN
WA37037OtherL&I