Provider Demographics
NPI:1659486645
Name:NILES, CATHERINE W (DC)
Entity type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:W
Last Name:NILES
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:CATHERINE
Other - Middle Name:E
Other - Last Name:WAAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1008 BETHEL AVE SE
Mailing Address - Street 2:STE A
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366
Mailing Address - Country:US
Mailing Address - Phone:360-895-7744
Mailing Address - Fax:360-895-1166
Practice Address - Street 1:1008 BETHEL AVE SE
Practice Address - Street 2:STE A
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366
Practice Address - Country:US
Practice Address - Phone:360-895-7744
Practice Address - Fax:360-895-1166
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3143111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T06232Medicare UPIN
WAG8004941Medicare PIN