1366581944 NPI number — LEW C ESTABROOK DC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366581944 NPI number — LEW C ESTABROOK DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEW C ESTABROOK DC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
NORTHWEST CHIROPRACTIC CENTER PLLC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366581944
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/01/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11821 NE 128TH ST STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KIRKLAND
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98034-7210
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-814-2800
Provider Business Mailing Address Fax Number:
425-823-0882

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11821 NE 128TH ST STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KIRKLAND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98034-7210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-814-2800
Provider Business Practice Location Address Fax Number:
425-823-0882
Provider Enumeration Date:
02/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ESTABROOK
Authorized Official First Name:
LEW
Authorized Official Middle Name:
C
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
425-814-2800

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0118558 . This is a "L&I GROUP NUMBER" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 2004943 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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