Provider Demographics
NPI:1609199405
Name:UPPER CERVICAL OF LYNDEN, INC
Entity type:Organization
Organization Name:UPPER CERVICAL OF LYNDEN, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:NEFF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-354-5341
Mailing Address - Street 1:115 7TH ST
Mailing Address - Street 2:
Mailing Address - City:LYNDEN
Mailing Address - State:WA
Mailing Address - Zip Code:98264-1950
Mailing Address - Country:US
Mailing Address - Phone:360-354-5341
Mailing Address - Fax:
Practice Address - Street 1:115 7TH ST
Practice Address - Street 2:
Practice Address - City:LYNDEN
Practice Address - State:WA
Practice Address - Zip Code:98264-1950
Practice Address - Country:US
Practice Address - Phone:360-354-5341
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-08
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2072403Medicaid
G8890075Medicare PIN
WA2072403Medicaid