Basic Information
| Provider Information | |||||||||
| NPI: | 1962416206 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SABELHAUS | ||||||||
| FirstName: | JEROME | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | DC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1963 BETHEL RD SE | ||||||||
| Address2: | |||||||||
| City: | PORT ORCHARD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983663108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3608715125 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1963 BETHEL RD SE | ||||||||
| Address2: | |||||||||
| City: | PORT ORCHARD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983663108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3608763393 | ||||||||
| FaxNumber: | 3608950447 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | CH00001032 | WA | Y | Chiropractic Providers | Chiropractor |
ID Information
| ID | Type | State | Issuer | Description | 2861805 | 05 | WA | MEDICAID |